Medicare Hospice Care

December 1, 2016

Opting for hospice care is never an easy decision.  When you choose hospice care, you decide that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness are not working.

You are eligible for hospice care if (a) you have Medicare Part A (Hospital Insurance), (b) referral/certification from your hospice or regular doctor that you are terminally ill, with a life expectancy of 6 months or less, (c) you accept palliative care for comfort, and (d) you sign a statement saying that you choose hospice care over other Medicare-covered treatments for your condition.

If you qualify and choose to opt for hospice care, you and your family will work with your hospice team to set up a care plan that meets your needs.  Including you, this team will have a hospice doctor, nurses and nurse practitioners, counselors, social workers, physical and occupational therapists, speech-language pathologists, hospice aides, homemakers, and volunteers.  You can also choose to have your regular doctor or nurse practitioner on the team.

Although hospice care is for people with a life expectancy of 6 months or less, you continue to receive care if you live longer, as long as the hospice medical doctor or your regular doctor recertifies that you are terminally ill with a life expectancy of 6 months or less.  Usually, Medicare covers you for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.  At the beginning of every period, your doctor must recertify your terminal illness and life expectancy.

Hospice care covers a number of health services that you can receive at home or a at a hospice inpatient facility.  If you opt for hospice care, you will be covered for the following Medicare services:

  • Doctor services
  • Nursing care
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Prescription drugs for symptom control or pain relief
  • Hospice aide and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social work 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
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team

*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 needed.

*You can change providers only once during each benefit period. 

You will not be covered for:

  • Treatment intended to cure your terminal illness and/or related conditions
  • Prescription drugs to cure your illness
  • Care from any hospice provider that wasn’t established by the hospice medical team
  • Room and board cost for getting hospice care at home or in a facility
  • Care you get as a hospital outpatient (like in an emergency room)
  • Care you get as a hospital inpatient
  • Ambulance transportation

Your cost for hospice care is zero, but you may need to pay a copayment of approximately $5 for drugs or treatments for pain relief and symptom control.  You may also need to pay 5% of the Medicare-approved amount for inpatient respite care.

You can choose to stop hospice care any time.  You will have to sign a form, and then you will return to the Medicare plan you had before opting for hospice care.  You can also choose to go back to hospice care, provided that you are eligible.

This is not a complete description of Medicare or covered hospice care benefits.  For more information and to speak with a Medicare specialist, contact Medigap, Inc. at 1-855-214-4404



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