Your Medicare Coverage

Is my test, item, or service covered?

Hospice & respite care

How often is it covered?

Hospice care is usually given in your home and includes these services when your doctor includes them in the plan of care for palliative care (for comfort) for your terminal illness and related condition(s):

  • Doctor services
  • Nursing care
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control or pain relief (may need to pay a small copayment)
  • Hospice aide and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care (for pain and symptom management)
  • Short term respite care (may need to pay a small copayment)
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team

When you choose hospice care, you've decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren't working.

Medicare won’t cover any of these once you choose hospice care:

  • Treatment intended to cure your terminal illness. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief).
  • Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • 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 a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care in an emergency room, inpatient facility care, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Who's eligible?

People with Medicare who meet all of these conditions are covered:

  • You're eligible for Medicare Part A (Hospital Insurance).
  • Your doctor certifies that you're terminally ill and are expected to have 6 months or less to live.*
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your terminal illness.

*In a Medicare-approved hospice, nurse practitioners aren't permitted to certify the patient's terminal illness, but after a doctor certifies the illness, the nurse practitioner can serve in place of an attending doctor. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies every 6 months that you continue to be terminally ill.

Your costs in Original Medicare

  • $0 for hospice care.
  • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it's covered under Part D.
  • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.

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