Is Hospice Covered By Medicare Part A or B?

Last Updated on January 3, 2025 by Frank Davis

Hospice care is an invaluable resource for individuals and families navigating the challenges of a terminal illness. For those enrolled in Medicare, understanding the coverage options for hospice care is crucial. One common question is whether hospice care is covered under Medicare Part A or Part B. The answer is straightforward: hospice care is covered under Medicare Part A, also known as Hospital Insurance.

What Is Medicare Part A?

Medicare Part A is a component of Original Medicare that primarily covers inpatient hospital care, skilled nursing facility care, some home health services, and hospice care. This part of Medicare is designed to provide coverage for services related to hospital stays and care that requires intensive medical support. Hospice care, which focuses on providing comfort and support for terminally ill patients, falls squarely within the scope of Medicare Part A.

Hospice Care: A Brief Overview

Hospice care is a specialized form of care that focuses on improving the quality of life for individuals with a terminal illness. Instead of seeking curative treatments, hospice care prioritizes pain management, symptom control, and emotional and spiritual support for both the patient and their family. It is typically provided in the patient’s home, a hospice facility, or a nursing home, depending on the individual’s needs and preferences.

To qualify for hospice care under Medicare, several conditions must be met:

1. Medicare Part A Enrollment: The individual must be enrolled in Medicare Part A.
2. Doctor’s Certification: A physician and a hospice medical director must certify that the patient is terminally ill, with a life expectancy of six months or less if the illness runs its normal course.
3. Choice of Hospice Care: The patient must choose to receive hospice care instead of treatments aimed at curing the illness.
4. Medicare-Approved Hospice Provider: The hospice services must be provided by a Medicare-approved hospice program.

What Hospice Services Does Medicare Part A Cover?

Medicare Part A provides comprehensive coverage for a variety of hospice services, ensuring that patients and their families have access to the support they need during a difficult time. Covered services include:

• Medical Care: Services for managing pain and other symptoms of the terminal illness.
• Nursing Care: Skilled nursing services provided by a registered nurse or licensed practical nurse.
• Medical Equipment and Supplies: Items such as hospital beds, wheelchairs, and bandages needed for the patient’s care.
• Medication: Prescription drugs for pain relief and symptom management.
• Social Worker and Counseling Services: Support for both the patient and their family, including grief and loss counseling.
• Spiritual Care: Chaplain services and spiritual support tailored to the patient’s beliefs.
• Home Health Aides: Assistance with activities of daily living such as bathing and dressing.
• Short-Term Inpatient Care: Care in a hospital or hospice facility for managing acute symptoms that cannot be handled at home.
• Respite Care: Short-term relief for caregivers, allowing them to take a break while the patient receives care in a Medicare-approved facility.

What Isn’t Covered by Medicare for Hospice Care?

While Medicare Part A offers extensive coverage for hospice care, there are some limitations. For example:

• Medicare does not cover treatments intended to cure the terminal illness.
• Room and board are not covered if hospice care is provided at home or in a nursing home (except during short-term inpatient stays for symptom management or respite care).
• Medicare does not pay for services provided by another healthcare provider that were not arranged or approved by the hospice team.

How to Access Hospice Care Under Medicare

To access hospice care through Medicare, patients or their families should first speak with their healthcare provider. Once a patient is deemed eligible, they can choose a Medicare-approved hospice provider to begin receiving care. It’s important to understand the scope of coverage and ask questions about any potential out-of-pocket costs, such as copayments for prescription drugs or respite care.

Conclusion

Hospice care provides critical support for patients and their families during a terminal illness, and Medicare Part A ensures that this care is accessible to eligible individuals. By focusing on comfort and quality of life, hospice care helps patients live their remaining days with dignity and peace. Understanding Medicare’s coverage for hospice care empowers families to make informed decisions and access the resources they need during this challenging time.