How Long Will Medicare Cover Hospice?

What Is Hospice Care Under Medicare?

Hospice care is a specialized type of care for people who are nearing the end of life due to a terminal illness. The goal is not to cure the illness but to manage symptoms, ease pain, and support emotional, spiritual, and psychological well-being. It is a holistic approach that also provides support to family members and caregivers.

Medicare offers a specific set of benefits under Medicare Part A for patients who qualify for hospice. These benefits cover a wide range of services, including medical support, personal care assistance, counseling, and spiritual services. All of these are designed to improve comfort and provide peace of mind.

Who Qualifies for Medicare Hospice Coverage?

Medicare has a few specific requirements for someone to receive hospice care under their plan. These requirements ensure that hospice is provided only when it is truly appropriate for the patient's condition. Here are the qualifications for various groups:

Diagnosis of a terminal illness: A doctor must certify that the patient has a life expectancy of six months or less if the illness runs its normal course.

Choosing palliative care over curative treatment: The patient must sign a statement choosing hospice care instead of treatments meant to cure their illness.

Receiving care from a Medicare-approved hospice provider: The hospice organization must be certified by Medicare. Anvoi Health meets all Medicare requirements and offers compassionate, professional care.

Once these conditions are met, the patient becomes eligible to receive hospice benefits under Medicare Part A.

How Long Does Medicare Cover Hospice Care?

This is where many families feel confused. While hospice care under Medicare is designed for those expected to live six months or less, coverage is not limited to exactly six months. In fact, Medicare allows hospice care to continue as long as the patient’s condition still qualifies.

Medicare breaks hospice coverage into benefit periods. Here is how those periods work:

1)  First 90-Day Benefit Period

The patient begins hospice care with an initial 90-day period. During this time, the care team focuses on managing symptoms and providing full supportive care. At the end of this period, a hospice doctor or the patient’s physician must recertify that the individual still has a terminal illness with a six-month life expectancy or less.

2) Second 90-Day Benefit Period

If the patient continues to meet the criteria, Medicare covers another 90-day period. The process is similar: the physician must confirm that the patient remains eligible for hospice care.

3) Unlimited 60-Day Benefit Periods

After the first two 90-day periods, Medicare provides an unlimited number of 60-day benefit periods. As long as the patient continues to meet the eligibility requirements, hospice care can continue. A physician must evaluate and recertify the patient’s condition at the start of each 60-day period.

There is no cap on the number of 60-day periods. In other words, hospice can continue for longer than six months, even for over a year, as long as medical professionals document that the terminal illness still exists.

Does Medicare Ever Stop Covering Hospice?

Medicare coverage for hospice does not simply end after a set number of days. However, there are a few reasons why coverage might stop:

1) The Patient’s Condition Improves

If the patient’s health improves and the doctor determines they are no longer terminally ill, the hospice benefit will end. Medicare coverage may then switch back to the traditional benefits under Parts A and B.

2) The Patient Chooses Curative Treatment

If the patient decides they want to try treatments aimed at curing the illness, they must revoke hospice care. Medicare does not allow hospice and curative treatments at the same time for the same illness.

3) The Patient Leaves Hospice

A patient can choose to stop hospice care at any time. For example, they may want to return to standard medical care or explore new treatment options. If they later decide they want hospice again, they can re-enroll, as long as they meet the eligibility requirements.

At Anvoi Health, we help guide families through these transitions with care and understanding. Our team works closely with physicians to make sure the right paperwork is submitted for continued coverage or re-enrollment.

What Services Does Medicare Cover Under Hospice?

One of the most helpful aspects of the Medicare Hospice Benefit is how many services it covers. These services are designed to support not only the patient but also their family members.

Here are the primary services Medicare covers under hospice:

• Physician and nursing services to monitor and manage symptoms.
• Medications related to the terminal illness to relieve pain and discomfort.
• Medical equipment such as hospital beds, wheelchairs, walkers, or oxygen supplies.
• Medical supplies like bandages, catheters, and gloves.
• Hospice aides to assist with daily activities such as bathing, dressing, and grooming.
• Spiritual and grief counseling for the patient and their loved ones.
• Social work services to help families handle practical matters and emotional stress.
• Short-term inpatient care when symptoms become too difficult to manage at home.
• Respite care to allow family caregivers to take a short break while their loved one receives care in a facility for up to five days.

All of these services are included at little or no cost to the patient.