Last Updated on June 19, 2024 by Frank Davis
Hospice care is for those who have a terminal illness, and their life expectancy is 6 months or less. When someone goes into hospice care, we attend to both the patient and their family’s physical, emotional, and spiritual needs. The goal of hospice care is to provide symptom and pain management care outside of a hospital setting, usually at home. Many people who enter hospice care are enrolled in Medicare, and we often get questions about how hospice care works with Medicare. In this article, we will discuss the basics of how hospice and Medicare work together.
Medicare Hospice Requirements and Benefits
Medicare has specific requirements for Medicare beneficiaries to enter hospice care. If you have a hospice doctor or a regular primary care physician, they must certify that you are terminally ill and have a life expectancy of 6 months or less. You will also have to sign a statement stating that you choose hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. Suppose you are approved for hospice care and are still receiving care after 6 months. In that case, your hospice doctor or hospice medical director will conduct a meeting in person and will recertify that you are still terminally ill and require continuing hospice care.
Medicare hospice care includes:
- All items and services needed for pain relief and symptom management
- Medical, nursing, and social services
- Drugs for pain management
- Durable medical equipment for pain relief and symptom management
- Aide and homemaker services
- Other covered services you need to manage your pain and other symptoms
- Spiritual and grief counseling for you and your family
If you are covered by Medicare, the following is an overview of your out-of-pocket costs related to hospice care:
- There are no out-of-pocket costs; you pay nothing for hospice care.
- You may have a copay of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while at home. There are some rare cases when the hospice benefit does not cover a particular drug you may need. In these rare cases, your hospice provider can contact the insurance company you purchased your Medicare Part D prescription drug plan from to see if your Part D plan covers it.
- You may have to pay 5% of the Medicare-approved amount for inpatient respite care.
One important thing to be aware of is that Medicare does not cover room and board if you get hospice care in your home or another facility like a nursing home.
How hospice works with Medicare Advantage or Medicare Supplement policies
If you are enrolled in a Medicare Advantage or Medicare Supplement plan once your hospice benefit starts, Original Medicare will cover everything related to your hospice care. You may choose to remain in a Medicare Advantage or Medicare Supplement Plan while receiving hospice care as long as you continue to pay your plan’s premiums. If you decide to remain enrolled in your Medicare Advantage Plan, you can still receive services provided by your Medicare Advantage plan that are not related to your terminal illness.
What Medicare won’t cover if you are in hospice
It is just as important to understand what Medicare won’t cover when you are in hospice as it is to understand what it will. Below is a list of the things that Medicare won’t cover once your hospice benefit starts:
- Treatment intended to cure your terminal illness and/or related conditions
- Prescription drugs to cure your illness (rather than for symptom control or pain relief)
- Care from any hospice or other provider that wasn’t set up by the hospice medical team you have chosen. All care for your terminal illness must be given by or arranged by the hospice team you chose.
- Medicare does not pay for room and board if you get hospice care at home or in a nursing home or hospice inpatient facility.
- Care you get as a hospital outpatient (like in an emergency room) unless it is arranged by your hospice team or is unrelated to your terminal illness and related conditions.
- Care you get as a hospital inpatient unless it is arranged by your hospice team or is unrelated to your terminal illness and related conditions.
- Ambulance transportation unless it is arranged by your hospice team or is unrelated to your terminal illness and related conditions.
It is critical that before you get any of these services, you talk to your hospice team, or you may have to pay the entire cost.
Through the use of both medicine and therapy, Hospice Valley of Los Angeles provides a wide variety of services to ease the pain associated with most terminal illnesses. We are approved Medicare hospice providers and are fully equipped and capable of caring for those even with the most sensitive health conditions. At times, patients prefer staying within the comfort of their own homes. We understand that completely, which is why we also offer hospice care to patients where they feel the safest.
