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Medicare Guidelines for Hospice Care: Who Qualifies and What’s Covered
Choosing hospice is a big decision, and it helps to have the Medicare rules explained in plain English. If you or someone you love is living with a serious illness, you might be weighing comfort at home against one more round of hospital visits. That is where Medicare’s hospice benefit comes in. It‘s designed to focus on pain relief, symptom control, and day-to-day support so you can spend more time together doing what matters. With the right team, many families feel less stress, fewer late-night emergencies, and more confidence about what to expect.
What Hospice Is (And Isn’t)
Hospice focuses on comfort, not cure. The goal is to manage pain and symptoms, support daily life, and help you and your family feel more at ease. It does not mean “giving up.” Many people live months on hospice with better comfort and less stress, and some even stabilize or improve for a while.
Who Qualifies for Medicare Hospice
Medicare hospice falls under Part A. You can qualify if all of the following are true:
- You have Medicare Part A.
- Your doctor and the hospice medical director certify that you have a life expectancy of six months or less if the illness runs its usual course.
- You choose hospice care instead of curative treatment for your terminal illness.
- Your condition fits hospice care goals, meaning comfort and quality of life take priority.
If your condition improves, you can leave hospice and return later if you need it. You can also revoke hospice at any time to pursue treatment.
The Four Levels of Hospice Care
Medicare recognizes four levels. Anvoi Health provides the level you need based on your symptoms on any given day.
1) Routine Home Care: Most common. Care comes to your home, assisted living, or nursing facility.
2) Continuous Home Care: Extra hours of nursing in your home during a pain or symptom crisis to help avoid hospitalization.
3) Inpatient Respite Care: A short stay, up to five days at a time, to give family caregivers a break.
4) General Inpatient Care: Short-term hospital or inpatient hospice stays for symptoms that can’t be managed at home.
What Medicare Covers Under Hospice
When care is related to your terminal illness and associated conditions, Medicare generally covers:
- Nursing and Physician Services for symptom management and care planning
- Medications for pain and symptom control (usually a small copay)
- Medical Equipment and Supplies like a hospital bed, oxygen, wheelchair, commode, dressings, and gloves
- Hospice Aide Help with bathing and personal care
- Social Work Support for planning, resources, and counseling
- Spiritual Care based on your beliefs and preferences
- Therapies such as physical, occupational, or speech therapy when used for comfort and safety
- Volunteer Support for companionship and practical help
- Short-Term Inpatient and Respite Care when needed
- Bereavement Support for your family for at least 13 months after a death
Medicare keeps paying for health needs not related to your terminal illness through your regular Medicare coverage. For example, if you need routine dialysis that is unrelated to the hospice diagnosis, that billing follows normal Medicare rules. Your Anvoi team helps sort out what is related and what is not so there are no surprises.
What Medicare Does Not Cover
A few things catch families off guard, so it’s better to know up front:
- Room and board at an assisted living or nursing facility are not covered by hospice. Hospice still visits and provides care there, but housing costs remain separate.
- Treatment meant to cure the terminal illness is not covered while you are on hospice. Comfort-focused treatments are covered.
- Emergency room or hospital stays that are not related to the hospice diagnosis may be billed to regular Medicare rather than hospice.
When something is unclear, Anvoi Health will walk you through what’s covered before services start.
Out-of-Pocket Costs
Hospice is designed to limit costs:
Medications: You may pay up to a small copay per prescription for comfort-related drugs.
Respite Care: You may owe 5 percent of the Medicare-approved amount for the respite stay.
Everything Else: Services and equipment related to the terminal illness are usually fully covered by Medicare.
We review costs with you at admission so you know exactly what to expect.
How Long Hospice Lasts
Hospice starts with two 90-day benefit periods. After that, there are unlimited 60-day periods. Before each new period, a recertification confirms that hospice is still appropriate. After day 180, Medicare requires a face-to-face visit to support ongoing eligibility. If you stabilize or improve, you can be discharged, and if needs return, you can re-enroll.
Where Care Happens
Most people receive hospice at home, which includes a private residence, assisted living, or a nursing facility. If symptoms flare or a caregiver needs a break, short inpatient or respite stays are available. The goal is to keep you wherever you feel safest and most comfortable.
Keeping Your Primary Doctor
You can keep seeing your primary doctor. Many patients like having both their regular physician and the hospice medical director involved. Anvoi Health coordinates with your doctors so your plan feels seamless.
Can You Change Your Mind?
Yes. You can leave hospice at any time to pursue treatment, and you can return to hospice later if you become eligible again. Your choices stay in your hands.
Talk With Anvoi Health
If you think hospice might help, or you just want straight answers about coverage, call Anvoi Health. We’ll check eligibility, explain costs in clear terms, and build a plan that feels right for you and your family. You do not have to figure this out alone. We’re here to make the hard parts simpler, keep you comfortable, and support the people you love.
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Anvoi has been providing hospice care since 2013 with over 100 years of accumulated experience.
