Hospice Care

Hospice is a program of care and support for people who are terminally ill. Here are some important facts about hospice:

Hospice helps people who are terminally ill live comfortably.

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.

Hospice isn’t only for people with cancer.

Family caregivers can get support.

What Medicare Covers?

You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and pain and symptoms management. You don’t need to choose hospice care to take advantage of this consultation service.

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.

Note: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness, such as care for an injury. Medicare covers the following hospice services when they’re needed to  care for your terminal illness and related condition(s):

Doctor services

Nursing care

Medical equipment (such as wheelchairs or walkers)

Medical supplies (such as 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 is Respite Care?

Respite care is a Temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient’s caregiver can rest or take some time off.

You can get inpatient respite care in a Medicare-approved facility (such as a hospice inpatient facility, hospital, or nursing home) if your usual caregiver (such as a family member) needs a rest. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but it can only  be provided on an occasional basis.

What Medicare Won’t Cover?

When you choose hospice care, you’ve decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren’t working. Medicare won’t cover any of the following once you choose hospice care:

Treatment intended to cure your terminal illness – 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 provider, unless you change your hospice provider. However, you can still see your regular doctor 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. However, 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 in an emergency room, inpatient facility care, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to 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?

Medicare pays the hospice provider for your hospice care. There is no deductible. You will have to pay the following:

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 will pay $5 per day. The amount you pay for respite care can change each year.

How Long You Can Get Hospice Care?

Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.

Note: Hospice care is given in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends.