Understanding Medicare Coverage for Hospice: What’s Included and What’s Not?

Making decisions about hospice care can feel overwhelming. Understanding what Medicare covers is crucial for families navigating this challenging time. Medicare’s hospice benefits provide important coverage for end-of-life care.

Who Qualifies for Medicare Hospice Coverage?

To receive Medicare hospice benefits, you must meet these criteria:

• Have Medicare Part A
• Your hospice doctor and regular doctor certify that you’re terminally ill with a life expectancy of 6 months or less
• Accept palliative care (comfort care) instead of curative treatment
• Sign a statement choosing hospice care over other Medicare-covered treatments

What Medicare Covers for Hospice Care

Medicare’s hospice benefit provides comprehensive coverage for services related to your terminal illness, including:

• Doctor services and nursing care
• Medical equipment (such as wheelchairs and walkers)
• Medical supplies (like bandages and catheters)
• Prescription drugs for symptom control and pain relief
• Hospice aide and homemaker services
• Physical and occupational therapy
• Speech-language pathology services
• Social worker 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 for your terminal illness

What’s Not Covered Under Medicare Hospice Benefits

Understanding what Medicare won’t cover is equally important:

• Treatment intended to cure your terminal illness
• Prescription drugs to cure your condition (rather than for symptom relief)
• Care from any provider not arranged by your hospice team
• Room and board in your home or a facility (unless the hospice team determines you need short-term inpatient or respite care)
• Care you get as a hospital outpatient or hospital inpatient, unless arranged by your hospice team
• Ambulance transportation, unless arranged by your hospice team

Costs and Payment Considerations

While Medicare covers most hospice services, you may have small copayments for:

• Up to $5 per prescription for outpatient drugs for pain and symptom management
• 5% of the Medicare-approved amount for inpatient respite care
• Your regular Medicare premiums

Making the Transition to Hospice Care

When considering hospice care, remember that:

• You can continue to see your regular doctor
• You can stop hospice care at any time
• You can receive care for conditions not related to your terminal illness through your regular Medicare benefits
• You can get hospice care for longer than 6 months if your doctor continues to certify you’re terminally ill

The Role of Professional Support

Having expert guidance through this journey is invaluable. At Qualicare, our Care Experts understand the complexities of hospice care and can help you:

• Navigate the transition to hospice care
• Coordinate with Medicare-approved hospice providers
• Ensure you receive all the benefits you’re entitled to
• Provide supplemental care and support as needed

Next Steps

If you’re considering hospice care for yourself or a loved one:

1. Talk with your doctor about whether hospice care is appropriate
2. Contact Medicare or your Medicare Advantage Plan to understand your specific coverage
3. Reach out to a Care Expert who can help guide you through the process

Don’t navigate this challenging time alone. Contact a Qualicare Care Expert today to learn more about how we can support you and your loved ones through the hospice journey while maximizing your Medicare benefits.