During hospice, the hospice provider should cover drugs for pain and symptom control and the medical equipment and supplies in your plan of care. Medicare's hospice booklet says you pay a copayment of up to $5 per prescription for those drugs. A bill for full price from a pharmacy or equipment company is worth questioning, though drugs for unrelated conditions may go through your Part D plan instead.
What should the hospice cover?
Medicare's booklet says that once hospice starts, Original Medicare covers everything you need related to your terminal illness and related conditions, through a Medicare-approved hospice. Depending on the plan of care, that can include:
- Prescription drugs for pain and symptom control.
- Medical equipment, like wheelchairs or walkers.
- Medical supplies, like bandages and catheters.
- Doctor and nursing care, aide services, therapy, and more.
The hospice team gives or arranges this care. For a broader look at what hospice costs, see hospice: what Medicare covers and what you may be billed.
What should I pay?
Medicare's booklet lists what you pay during hospice:
- Your monthly Part A (if any) and Part B premiums.
- A copayment of up to $5 per prescription for outpatient drugs for pain and symptom management.
- 5% of the Medicare-approved amount for inpatient respite care.
There's no deductible. So a pharmacy charging full price for a hospice pain medicine, or an equipment company billing monthly rent for a hospice bed, are signs something went to the wrong place.
When does my Part D plan pay instead?
Medicare's booklet says drugs that aren't for your terminal illness or related conditions aren't part of the hospice benefit. They may be covered by your Part D plan, with your usual copay.
For example, a cholesterol pill unrelated to a cancer diagnosis would likely go through Part D. A pain medicine for the cancer would go through hospice.
The booklet also says that in the rare case the hospice benefit doesn't cover a drug, the hospice should contact your drug plan to find out whether the plan covers it.
Medicare.gov says you can ask your hospice for a list of items, services, and drugs it has decided aren't related to your terminal illness. That list helps sort out who should pay.
Why would a pharmacy bill me full price?
Some common mix-ups:
- The pharmacy billed your Part D plan for a drug that should go to hospice, and the plan rejected it.
- The hospice uses a specific pharmacy, and the prescription was filled somewhere else.
- The drug was prescribed by a doctor the hospice didn't know about.
What to say to the pharmacy:
"[Patient name] is in hospice with [hospice name]. Is this drug for their hospice condition? If so, it should go to the hospice. Can you hold the charge while I check with the hospice nurse?"
What to say to the hospice:
"The pharmacy charged us $[amount] for [drug] on [date]. Is this drug part of the hospice plan of care? If so, how should the pharmacy bill it, and can you help us get the charge reversed?"
What about equipment bills?
If an equipment company bills you or Medicare Part B for a hospital bed, oxygen, wheelchair, or similar item during hospice, ask whether the hospice should be covering it.
Sometimes the equipment was in place before hospice started, under a regular Medicare rental. Once hospice starts and the item is for the terminal illness, the hospice should arrange it. Ask the hospice and the supplier to sort out the switch.
What to say to the equipment supplier:
"[Patient name] started hospice with [hospice name] on [date]. Is this [item] being billed to Medicare Part B? If it's part of the hospice care, it should be handled by the hospice. Can you check with them and correct the bill?"