June 21, 2024
Does Medicare Pay For Hospice

Hospice care is patient-centered care for people near end of life. If you or a loved one are in need of hospice care, Medicare Part A provides a hospice benefit that can cover most of the costs. However, as you begin to evaluate care options, it’s important to understand who’s eligible for hospice care and what services are covered.


Our guide to Medicare hospice benefits includes information on the four types of hospice care, what Medicare covers and possible out-of-pocket costs. Read on to learn more.

What is hospice care?

Hospice care, sometimes referred to as “comfort care,” is a program of care and support for people who are terminally ill and their families. Someone who receives hospice care has a life expectancy of six months or less, if the illness runs its normal course.


Hospice care services are focused on comfort, so the person will receive physical care, counseling, equipment and drugs for the terminal illness and related conditions. However, treatments to cure the illness are not part of hospice care.


Anyone who has Medicare coverage or a Medicare Advantage Plan is eligible to receive the benefit through Original Medicare. For those who are insured by Medicaid, hospice care benefits vary by state. Many private insurance companies also provide hospice care.


Who qualifies for hospice care?

To qualify for hospice care, a person must receive certification from a physician (usually their primary care doctor or a specialist) as well as a hospice physician. However, even without a physician’s recommendation, the person’s caregiver can request care from a local hospice program provider.


The person who receives hospice care may:


Be diagnosed with a terminal illness or advanced stages of Alzheimer’s or dementia

Have a prognosis of six months or less to live, according to physicians

Be experiencing a significant decline in health (physical and/or mental) despite medical treatment

Some of the most common diagnoses of people in hospice care include cancer, cardiovascular disease, debilitating strokes, amyotrophic lateral sclerosis (ALS), age-related dementia and AIDS.

Does Medicare pay for hospice?

Medicare pays for hospice care under Part A (hospital insurance) of Original Medicare. Even if you have a Medicare Advantage Plan (Part C) through a private company, you are still eligible for coverage. The Medicare hospice benefit includes care for up to two 90-day periods, and an unlimited number of 60-day periods thereafter.


To qualify, the person receiving care must have a life expectancy of six months or less as certified by a doctor as well as a hospice doctor. The caregiver must also sign a statement choosing hospice over alternative, Medicare-covered treatments that aim to cure the terminal illness in question. Additionally, for the participant to qualify for coverage, the care providers must be Medicare-approved.


Hospice care covered by Medicare

The Medicare hospice benefit covers care costs up to a specified limit and for set periods. To qualify, you must use Medicare-approved hospice providers for home care. If you elect to use a hospice facility, it must also be approved by Medicare.

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