Medicare Hospice Benefit — Hospice care
Medicare's Hospice Benefit covers comfort care for people with a terminal illness and a life expectancy of 6 months or less, at very low out-of-pocket cost.
Official source: medicare.gov
The Medicare Hospice Benefit is a Part A program that covers comfort-focused care for people with a terminal illness. The goal shifts from curing disease to managing pain, supporting quality of life, and helping families.
To qualify, a doctor must certify that the illness is terminal with a life expectancy of six months or less if the disease follows its normal course. You agree to focus on comfort care rather than curative treatment for that terminal condition. You can leave hospice at any time and resume regular Medicare coverage.
Hospice covers nursing visits and 24-hour phone support, doctor services tied to the terminal diagnosis, pain and symptom medications, durable medical equipment, home health aide visits, social work, spiritual counseling, and bereavement support for the family. It does not cover treatments aimed at curing the terminal illness, room and board in a nursing home, or care unrelated to the terminal diagnosis.
Coverage runs in two 90-day benefit periods followed by unlimited 60-day periods, as long as the doctor recertifies eligibility. There is no lifetime limit on hospice days.
Costs are minimal. There is no deductible or coinsurance for most hospice services. You may pay up to $5 per prescription for comfort medications and 5% of the Medicare-approved amount for inpatient respite care that gives family caregivers a short break.
In real life
- A patient with advanced cancer elects hospice at home. Medicare pays for the hospice nurse, hospital bed, oxygen, pain medications, and a home health aide. The family pays a small copay on comfort drugs and nothing for the nursing visits.
Also known as
Frequently asked questions about Medicare Hospice Benefit
Who qualifies for the Medicare hospice benefit?+
A doctor and the hospice medical director must certify a terminal illness with a life expectancy of six months or less if the illness follows its normal course.
How much does Medicare hospice cost?+
Most services have no deductible or coinsurance. You may pay up to $5 per comfort medication and 5% for short inpatient respite care.
Can I leave hospice if my condition changes?+
Yes. You can stop hospice at any time and return to regular Medicare coverage, including curative treatment.
Does Medicare hospice cover room and board in a nursing home?+
No. Medicare pays for the hospice services themselves, but not the nursing home room and board.
Is there a time limit on the Medicare hospice benefit?+
There are two 90-day periods, then unlimited 60-day periods as long as you remain eligible. There is no lifetime cap.
Source: medicare.gov