Medicare Hospice Benefit
The Medicare hospice benefit covers care related to a terminal illness.
Medicare is a health insurance program for people 65 years of age and older. It's also for some people younger than 65 who have disabilities. And it's for people with long-term (chronic) kidney failure treated with dialysis or a transplant. It's administered by the Centers for Medicare and Medicaid Services.
The Medicare hospice benefit is described in Part A. Part A benefits cover hospitals and nursing facilities (but not custodial or long-term care). They also cover some home health care, as well as hospice. People (including a spouse) who paid Medicare taxes while they were working are eligible for Part A benefits. You don't have to pay a monthly payment, or premium, for Part A benefits.
You must meet all of the criteria below to be eligible for the Medicare hospice benefit:
- You must be eligible for Medicare Part A benefits.
- Your doctor and hospice medical director must certify that you have a terminal illness and are likely to live 6 months or less if your illness follows a normal course.
- You must sign a statement that says you choose hospice care instead of other Medicare-covered benefits to treat your illness. (Medicare will still cover services for any health problem that isn't related to your terminal illness.)
- You must get care from a hospice approved by Medicare.
For more information, visit the Centers for Medicare and Medicaid Services website at www.cms.gov or call them at 1-800-633-4227.
Medicare pays the hospice program a daily (per diem) rate. The rate is intended to fully cover most services related to a terminal illness. These may include:
- Hospice nursing care in your home. This includes intermittent visits by a nurse to check on your symptoms. Nurses are also available 24 hours a day, 7 days a week, to visit if you need help. Live-in nursing care isn't covered.
- Medical supplies and equipment. Examples are wheelchairs, hospital beds, and incontinence pads.
- Medicines for symptom control and pain relief. You will have to pay no more than $5 for each prescription drug and other related products.
- Visits to your doctor to help manage your illness.
- Intermittent homemaker and home health aide services. The service of a live-in homemaker or home health aide isn't covered.
- Physical, occupational, or speech therapy, if needed because of your illness.
- Dietary counseling.
- Visits from a counselor or social worker.
- Spiritual care.
- Visits from trained volunteers. They are available on a short-term basis to provide companionship, to help with your care, or to run errands.
- Short-term respite care so your caregiver can rest or take some time off. You may need to pay a small copayment.
- Temporary hospital stay, if you need it, to help manage symptoms that can't be controlled at home.
- Counseling (called bereavement care) for your family, friends, and caregivers after your death.
If your condition changes so that hospice is no longer right for you, you can get your former Medicare benefits reinstated. You can also re-apply for hospice benefits at a later time if you need them.
Current as of: March 9, 2022
Author: Healthwise Staff
Anne C. Poinier MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Shelly R. Garone MD, FACP - Palliative Medicine