hospice medicare benefit
Medicare Hospice Benefits
- Hospice helps people who are terminally ill live comfortably.
- Hospice isn’t only for people with cancer.
- The focus is on comfort, not on curing an illness.
- A specially trained team of professionals and caregivers provide care for the “whole person,” including his or her physical, emotional, social, and spiritual needs.
- Services may include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition(s).
- Care is generally provided in the home.
- Family caregivers can get support.
Medicare hospice benefits
- You’re eligible for Medicare Part A (Hospital Insurance).
- Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
- You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.)
- You get care from a Medicare-approved hospice program.
How hospice works
If you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness.
You and your family members are the most important part of the team. Other people on the team may include:
- Nurses or nurse practitioners
- Social workers
- Physical and occupational therapists
- Speech-language pathologists
- Hospice aides
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.
A hospice doctor is part of your medical team. Your regular doctor or a nurse practitioner can also be part of this team as the attending medical professional to supervise your care. However, only your regular doctor (not a nurse practitioner that you’ve chosen to serve as your attending medical professional) and the hospice medical director can certify that you’re terminally ill and have 6 months or less to live.
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.
What Medicare covers
Medicare will cover the hospice care you get for your terminal illness, but the care you get must be from a Medicare-approved hospice program.
Important: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness, like care for an injury.
Medicare covers these hospice services when they’re needed to care for your terminal illness and related condition(s):
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control or pain relief (may need to pay a small copayment)
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (may need to pay a small copayment)
- Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team
What Medicare won’t cover
- Treatment intended to cure your terminal illness
Note: Contact your hospice team before you get any of these services or you might have to pay the entire cost.
What you pay for hospice care
- No more than $5 for each prescription drug and other similar products for pain relief and symptom control.
- 5% of the Medicare-approved amount for inpatient respite care. For example, if Medicare pays $100 per day for inpatient respite care, you’ll pay $5 per day. The amount you pay for respite care can change each year.
Hospice care if you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan
Care for a condition other than your terminal illness
For more information about Original Medicare, Medicare Advantage Plans, and other Medicare health plans, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Medicare.gov. You can also call 1-800-MEDICARE.
Your Medicare rights
Medicare.gov/appeals or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
- Call National Hospice Associations, or visit their Web sites.
National Hospice Palliative Care Organization (NHPCO) nhpco.org
1731 King Street
Alexandria, Virginia 22314
228 7th Street, SE
Washington, DC 20003
TTY users should call 1-877-486-2048
Note: At the time of printing, these phone numbers and websites were correct. This information sometimes changes. To get the most updated phone numbers and websites, visit Medicare.gov/contacts or call 1-800-MEDICARE.