If you qualify for hospice care, you and your family will work with the hospice team to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your national or state hospice organization.
You and your family members are the most important part of a team that may also include:
- Nurses or nurse practitioners
- Social workers
- Physical and occupational therapists
- Speech-language pathologists
- Hospice aides
A hospice doctor is part of your medical team. You can also choose to include your regular doctor or a nurse practitioner on your medical team, as the attending medical professional who supervises your care.
In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week, to give you and your family support and care when you need it.
Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have 6 months or less to live.
Where you get hospice care
The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay.
How long you can get hospice care
Hospice care is intended for people with a life expectancy of 6 months or less (if the disease runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill (with a life expectancy of 6 months or less).
- You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
- You have the right to change providers only once during each benefit period.
- At the start of each period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill (with a life expectancy of 6 months or less), so you can continue to get hospice care.
Finding a hospice program
Consider these questions when choosing hospice care providers:
- Is the hospice program certified and licensed by the state or federal government?
- Does the hospice provider train caregivers to care for you at home?
- How will your doctor work with the doctor in the hospice program?
- How many other patients are assigned to each member of the hospice care staff?
- Will the hospice staff meet regularly with you and your family to discuss care?
- How does the hospice staff respond to after-hour emergencies?
- What measures are in place to ensure hospice care quality?
- What services do hospice volunteers offer? Are they trained?
The hospice program you choose must be Medicare-approved to get Medicare payment. To find out if a certain hospice program is Medicare-approved, ask your doctor, the hospice program, your state hospice organization, or your state health department.
If you're in a Medicare Advantage Plan or other Medicare health plan
Once you choose hospice care, your hospice benefit should cover everything you need. Original Medicare covers all Medicare-covered services you get while in hospice care, even if you were previously in a Medicare Advantage Plan or other Medicare health plan. If your plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services as long as you continue to pay your premium.
Care for your other conditions
Your hospice benefit covers your care and you shouldn’t have to go outside of hospice to get care (except in very rare situations). Once you choose hospice care, your hospice benefit should cover everything you need.
You must pay the deductible and coinsurance amounts for all Medicare-covered services to treat health problems that aren’t part of your terminal illness and related conditions. You also must continue to pay Medicare premiums, if necessary.
Stopping hospice care
If your health improves or your illness goes into remission, you may no longer need hospice care. You always have the right to stop hospice care at any time for any reason.
If you stop your hospice care, you’ll get the type of Medicare coverage you had before you chose a hospice program, like Original Medicare, a Medicare Advantage Plan, or another type of Medicare health plan. If you’re eligible, you can go back to hospice care at any time.