You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:
- Your 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).
- 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-certified hospice care is usually given in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need.
- You pay nothing for care.
- You pay a Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them. of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to see if
- You may pay 5% of the for inpatient respite care.
- You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.
Depending on your terminal illness and related conditions, your hospice team will create a plan of care that can include any or all of these services:
- Doctors' services.
- Nursing and medical services.
- Durable medical equipment for pain relief and symptom management.
- Medical supplies, like bandages or catheters.
- Drugs for pain management.
- Aide and homemaker services.
- Physical therapy services.
- Occupational therapy services.
- Speech-language pathology services.
- Social services.
- Dietary counseling.
- Spiritual and grief counseling for you and your family.
- Short-term inpatient care for pain and symptom management. This care must be in a Medicare‑approved facility, like a hospice facility, hospital, or skilled nursing facility that contracts with the hospice.
- Inpatient , which is care you get in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a family member or friend) can rest. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.
- Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.
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).
Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re still terminally ill.
Medicare won't cover any of these once your hospice benefit starts:
- Treatment intended to cure your terminal illness and/or related conditions. 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 hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner 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 you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions.
Contact your hospice team before you get any of these services or you might have to pay the entire cost.