Medicare Part A covers hospice care when a hospice doctor and your regular doctor (if you have one) certify that you're terminally ill with a life expectancy of 6 months or less, and you choose comfort care instead of treatment to cure the illness. For hospice care itself, Medicare.gov says you may pay a copayment of up to $5 for each prescription for pain and symptom management and 5% of the Medicare-approved amount for inpatient respite care. Medicare doesn't pay room and board if you get hospice care at home or in a nursing home.
Who qualifies for Medicare hospice?
According to Medicare.gov, you qualify if you have Part A and:
- Your hospice doctor and your regular doctor (if you have one) certify you're terminally ill, with a life expectancy of 6 months or less.
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Medicare.gov also notes that only your hospice doctor and your regular doctor can certify that you're terminally ill.
What does hospice cover?
Hospice covers the care you need for your terminal illness and related conditions. All of that care must be given or arranged by the hospice team. This can include doctor and nursing services, medical equipment and supplies, drugs for pain and symptom control, aide and homemaker services, therapy, social work, dietary counseling, and grief support for the family.
Hospice care is often given at home. It can also be given in a nursing home or a hospice facility.
What will I still pay with hospice?
Medicare.gov lists these costs:
- Prescription copays. Up to $5 for each prescription for outpatient drugs for pain and symptom management.
- Respite care. You may pay 5% of the Medicare-approved amount for inpatient respite care. Respite care is a short stay in a facility so the family caregiver can rest, for up to 5 days at a time.
- Room and board. Medicare doesn't cover room and board if you get hospice care in your home, or if you live in a nursing home or hospice inpatient facility. The exception: if the hospice team arranges short-term inpatient or respite care, Medicare covers that stay.
For a parent who lives in a nursing home, the room and board bill usually keeps coming from the nursing home after hospice starts. Medicaid may help pay it for people who qualify.
What about care unrelated to the terminal illness?
Original Medicare still covers care for health problems that aren't part of the terminal illness or related conditions. For those services, the usual deductibles and coinsurance apply.
Medicare.gov says you can ask your hospice for a list of items, services, and drugs they've decided aren't related to your terminal illness. You can also ask for an addendum to your hospice election statement that lists what the hospice won't cover because it's unrelated.
This is useful when checking bills. If you get a bill from a doctor or pharmacy during hospice, ask whether it's for the terminal illness (which the hospice should cover) or something unrelated.