Does Medicare Cover Hospice?

Medicare coverage for hospice care is available if you qualify per Medicare guidelines and use a Medicare-approved hospice provider. However, not all circumstances warrant Medicare coverage for hospice. So, you’ll need to thoroughly understand the guidelines to ensure your needs are covered. While there are Medicare guidelines for hospice, for those who qualify, benefits will provide coverage for everything needed to help cover your terminal illness.

In general, Medicare coverage for hospice is a great perk if you meet the requirements. Hospice allows you or your loved one to be as comfortable as possible with specialized care when nearing the end of life.

Does Medicare Pay for Hospice?

Hospice is a health care program that helps support people with terminal illnesses and those with a life expectancy of six months or less. This allows people to live more comfortably and provide support to the family. Medicare hospice coverage through Part A is available, and if you meet the terms, you may qualify. If your hospice provider accepts Medicare assignment, then you’ll likely receive coverage.

Medicare covers hospice in relation to terminal illness. Typically, patients will get hospice care in the comforts of their homes. However, it may be in an inpatient hospice center.

Depending on your special needs, hospice care might cover doctor services. This can include prescriptions, nursing care, medical devices, counseling services, and medical supplies. To determine if your doctor accepts Medicare, you can check with your state, your doctor, or the facility.

Medicare Hospice Guidelines

The Medicare hospice benefit is available for beneficiaries, but some guidelines apply. For a patient to be eligible for hospice, they must have a life expectancy of six months or less, have Medicare Part A coverage, and just want to receive comfort care over treatment.

If a hospice program partners with Medicare, there are some standards that the hospice facility must meet to be compliant. Not only does this help the hospice facility, but it can often bring peace of mind to patients and family members. This includes the Medicare guidelines for inpatient hospice and nursing homes as well.

For any beneficiary who receives hospice care, written certification must include the following, according to Medicare:

• If you are receiving care from them at the time, your hospice provider and regular doctor must certify your terminal illness and only have a life expectancy of 6 months or less.
• You are accepting comfort care, also known as palliative care, rather than receiving healthcare for curing your illness.
• You’ll also need to sign a statement that says you are choosing hospice care rather than other Medicare-covered treatments for your terminal illness and related conditions.

Medicare and hospice coverage doesn’t have to be a hassle; we’re here to help. By contacting our team of licensed Medicare agents, you can receive help every step of the way to ensure that you have the hospice Medicare benefit you deserve.

How Long Will Medicare Pay for Hospice Care?

Medicare pays for hospice care in two 90-day periods. After this, you can receive an unlimited amount of 60-day benefit periods. You can also switch hospice providers once per benefit period. Only your hospice provider and regular doctor can certify your terminal illness, and they must do so at the start of the first 90-day period.

At the start of each benefit period after your first 90-day period, you’ll need the hospice medical director or another hospice provider to recertify your terminal illness. By doing so, you can continue to receive hospice care. Even if you live longer than six months, hospice care may still be available. Still, again, your hospice medical director or another hospice provider must recertify your health status as terminally ill.

Does Medicare Cover 24-Hour Hospice Care?

Medicare hospice coverage does include 24-hour care, but these instances are rare. In most cases, coverage for 24-hour hospice care is only available when a patient’s health has declined to the point that continuous care becomes medically necessary.

There are different levels of hospice care available depending on your medical needs. Again, continuous, 24-hour hospice care is provided to patients in their homes that require constant care at all hours of the day.

Medicare Part A specifically covers the doctors and nurses providing 24-hour care to the patient and may provide coverage for other levels of hospice care as they become necessary, including short-term inpatient care or respite care.

But all patients in hospice care receive a doctor and nurse that are available 24/7. Therefore, even if you do not require 24-hour care, a team of medical professionals is still on-call and available to you and your family during this time.

How Much Does Medicare Pay for Hospice per Day?

Medicare coverage for hospice pays 100% of hospice care for those who qualify. This includes coverage for prescriptions, doctors’ visits, counseling services, physical therapy, and medical supplies.

If you choose to get hospice care from within the comforts of your own home, nursing home, or long-term care facility, Medicare doesn’t cover the “room and board” portion. Additionally, other costs may persist with Original Medicare alone. To cover these expenses, choosing the right Medicare Supplement plan can help.

Palliative Care vs. Hospice Care Medicare Coverage

Palliative care is a form of healthcare that primarily focuses on pain relief and management for patients who are ill. It’s a part of hospice care and is covered by Medicare Part A when medically necessary.

Although palliative care is a component of hospice care, there are some notable differences to consider. For example:

• While receiving hospice care requires two doctors certifying a patient has six months or less to live, palliative care can be applied even if the patient is not suffering from a terminal disease or not.
• Hospice care means forgoing curative care, whereas palliative care occurs at the same time a cure is being sought for patients.
• In general, palliative care, exclusively, isn’t covered by Medicare. However, as they can be a part of your hospice treatment, if they are medically necessary, Medicare will cover the healthcare services.

Who Pays for Hospice if Not on Medicare?

Suppose you do not have Medicare hospice coverage. In that case, you’ll likely have to pay for it either out of your own pockets, through a private insurance plan, or through a health maintenance organization (HMO). However, most of those receiving hospice are eligible for Medicare.

Rising healthcare costs can be a massive concern for those in need of hospice care if they do not have Medicare. However, because most people needing hospice care are eligible for Medicare, your costs are covered through the program.

Speaking with a licensed insurance agent can help you enroll in the coverage you need to cover an array of healthcare services, including hospice care.

Does Medicare Cover Hospice for Dementia?

Yes, your Medicare hospice benefit will cover dementia if the condition is certified by the hospice provider and your regular doctor as being a terminal illness with only six months to live. There are many different guidelines for dementia as each case is different, but if your healthcare providers determine the condition to require hospice care and you are eligible for Medicare, you’re covered.

Does Medicare Cover Hospice Care in a Skilled Nursing Facility?

Yes, Medicare will cover hospice care in a skilled nursing facility, but only if it has a contract with a Medicare-certified hospice that provides the care. Remember, your coverage for hospice doesn’t include room and board at a skilled nursing facility.

There are four different types of hospice care, including routine home care, continuous home care (24-hour care), inpatient respite care, and general inpatient care. If you are receiving routine home care, you may be able to receive healthcare services at a skilled nursing facility.

Patients with Medicare Part A are covered if they receive care for the same condition as they were during their hospital stay after entering a Medicare-certified skilled nursing facility within 30 days of leaving the hospital. Additionally, under these circumstances, beneficiaries must also need skilled nursing care seven days per week or skilled therapy services at least five days per week.

To find a skilled nursing facility capable of helping you during hospice care, you’ll need to speak with your medical team about appropriate facilities in your area. Remember, your skilled nursing facility much be Medicare-certified in order to use your benefits. For those with Medicare Advantage, you’ll also need to look at your plan, contact your provider, and discover which skilled nursing facilities are in your network.

Medigap plans do not have networks. Therefore, if you have a Medicare Supplement plan, you can enjoy supplemental coverage regardless of the network for your skilled nursing facility.

Does Medicare Advantage Cover Hospice?

No, while Medicare Advantage plans must cover the same services as Original Medicare, there is an exception for hospice care. That said, eligible hospice services are still covered by Original Medicare.

However, copayments and potential costs may still be left over even with Original Medicare. Medicare Advantage and hospice coverage may not cover all of the costs associated with your care.

For beneficiaries looking to cover these costs, Medicare Supplement Plans, also known as Medigap plans, can also help cover the copayments and coinsurance Medicare leaves for you when receiving hospice care. Medigap plans can even cover the deductibles Medicare sets each year. But it should be known that you can only have either a Medicare Advantage plan or Medicare Supplement plan, not both at once.

Does Medicare Cover End-of-Life Counseling?

Yes, since 2016, Medicare covers end-of-life counseling, which is a chance to review your options regarding your healthcare and any available treatments for you and your condition. These treatments can be palliative or aggressive, and your doctor will help present expectations of your options.

If a beneficiary doesn’t want to move forward with curative medical treatment, they may choose to utilize their coverage for hospice covered by Medicare towards end-of-life care.

Medicare Advance Care Planning

Medicare covers advanced care planning and has since 2016. This allows beneficiaries the opportunity to plan for care in the event that they are no longer capable of speech. Your annual wellness visit under Medicare Part B includes coverage for voluntary advanced care planning.

How To Qualify for Hospice Under Medicare

Medicare coverage of hospice care is available, and if you’re looking to enroll, we can help. Our team of licensed insurance agents can help you find coverage for hospice care through Original Medicare and supplemental coverage.

We’re here for you every step of the way and can help you find a coverage option that works for your healthcare and your budget. Call us at the number above to compare options available in your area, or complete our online rate form to discover Medicare hospice benefits today!

Enter ZIP Code

Enter your ZIP code to pull plan options available in your area.

Compare Plans

Select which Medicare plans you would like to compare in your area.

Get Quote

Compare rates side by side with plans & carriers available in your area.