Does Medicare Cover Hospice? Understanding Your Coverage Options

What Is Hospice Care?

Hospice care provides medical, emotional, and spiritual support for patients who are living with a terminal illness and have a life expectancy of six months or less. The goal is not to cure the illness but to ensure that the person remains as comfortable and supported as possible. Services can be provided in the home, in a hospice facility, or at a nursing home. Care typically includes pain management, symptom control, emotional support, and assistance for both patients and their families.

Does Medicare Cover Hospice?

Yes, Medicare does cover hospice care through Medicare Part A. To qualify, a person must meet all of the following requirements:

• Be eligible for Medicare Part A
• Receive certification from a doctor and the hospice medical director confirming a terminal illness with a life expectancy of six months or less
• Choose hospice care instead of curative treatment
• Receive care from a Medicare-certified hospice provider like Anvoi Health

Once a patient elects the hospice benefit, they receive care that focuses on comfort, not cure.

What Hospice Services Does Medicare Cover?

Medicare’s hospice benefit is designed to cover a wide range of services related to the terminal diagnosis. These include:

• Regular visits from a registered nurse
• Services from a hospice physician
• Medications for pain relief and symptom control
• Medical equipment such as hospital beds, wheelchairs, and oxygen
• Medical supplies like wound care dressings and catheters
• Certified nursing assistants to help with daily care
• Homemaker services
• Social work and counseling support
• Chaplain services for spiritual care
• Grief and bereavement support for families (up to 13 months after death)
• Short-term inpatient care for symptom management
• Respite care to give caregivers a break (limited to 5 consecutive days per benefit period)

These services aim to improve the quality of life for patients and ease the burden on caregivers.

What Medicare Does Not Cover

While Medicare covers many aspects of hospice care, it does not cover everything. Here are some examples of services that are not covered:

• Treatment aimed at curing the terminal illness
• Prescription drugs not related to symptom control or pain relief
• Room and board (unless during inpatient or respite care)
• Emergency services unrelated to the hospice diagnosis
• Care provided by a non-Medicare-approved hospice agency

It is important to talk with your hospice provider to understand exactly what is included and what is not.

Additional Coverage Options Beyond Medicare

Some patients may have other types of insurance that can work alongside or instead of Medicare. These options include:

Medicaid: Many states offer hospice benefits through Medicaid for low-income individuals who meet certain requirements.

Private Insurance: Coverage may vary depending on the plan but often mirrors Medicare benefits. Some plans require co-pays.

Veterans Benefits: The Department of Veterans Affairs offers hospice care to eligible veterans, often with no out-of-pocket costs.

Medicare Advantage Plans: When a patient enters hospice care, their Medicare Advantage Plan usually shifts back to Original Medicare for hospice-related services, but the plan may still cover non-hospice services like dental or vision.

A knowledgeable hospice provider can help you review all your options.