Does Insurance Cover Hospice?
Palliative care
A hospice doctor and your doctor (if you have one) must both certify that you are terminally ill, meaning you have a life expectancy of six months or fewer, to be eligible for hospice treatment. When you choose hospice care, you’re opting for palliative care rather than treatment to cure your sickness. You must also sign a declaration stating that you prefer hospice care to other Medicare-covered services for the treatment of your terminal disease and accompanying disorders. All materials and services required for pain relief and symptom management are covered, as well as medical, nursing, and social services.- Analgesics (pain relievers)
- Long-lasting medical equipment for symptom control and pain relief
- Homemaker and aide services
- Other services that are covered You and your family will need to manage your pain and other symptoms, as well as spiritual and grieving counsel ling.
Your Original Medicare Expenses
- Hospice care is free of charge.
- For outpatient pain and symptom management medicines, you pay a co-payment of up to $5 per prescription. If your drug isn’t covered by the hospice benefit, your hospice provider should check with your plan to determine if Part D covers it.
- For inpatient respite care, you can pay up to 5% of the Medicare-Approved Amount.
- What it entails
- Your hospice team’s plan of care may include any or all of the following services, depending on your terminal disease and concomitant conditions:
- Medical services
- Medical and nursing services
- Long-lasting medical equipment for symptom control and pain relief
- Medical supplies such as bandages and catheters
- Pain-relieving medications
- Aide and homemaker services
- Occupational therapy services
- Physical therapy services
- Services in speech-language pathology
- Assistance with social issues
- Spiritual and grief counseling for you and your family
- Dietary counseling
- Pain and symptom treatment in a short-term inpatient setting. This care must be provided in a Medicare-approved facility, such as a hospice, hospital, or skilled nursing facility with which the hospice has a contract.
- Inpatient respite care is care provided in a Medicare-approved facility (such as an inpatient facility, hospital, or nursing home) so that your primary caregiver (such as a family member or friend) can take a break. This will be handled by your hospice provider. Each time you obtain respite care, you can stay for up to 5 days. You can get respite care multiple times, but only on an as-needed basis.
- Any other services that your hospice team advises for managing your pain and other symptoms connected to your terminal disease and related illnesses that Medicare covers.
What You Should Know
Only your hospice doctor and your normal doctor (if you have one) can certify that you’re terminally sick with a six-month or shorter life expectancy. If the hospice medical director or hospice doctor re certifies (at a face-to-face meeting) that you’re still terminally ill after 6 months, you can continue to receive hospice care. Hospice care is typically provided in the patient’s home, although it may also be provided at a hospice inpatient facility. Original Medicare will continue cover covered benefits for any health issues that aren’t related to your terminal disease, although this is unusual. When you choose hospice care, you have decided that you no longer want treatment to cure your terminal illness, or your doctor has determined that treatment isn’t working. Once you’ve decided on hospice care, your hospice benefit will usually cover all your needs.Once your hospice benefit begins, Medicare will not cover any of the following
- Treatment aimed at curing your terminal illness and/or its symptoms. If you’re considering of obtaining therapy to cure your sickness, talk to your doctor first. You have the right to terminate hospice care at any moment as a hospice patient.
- Prescription medications to help you recover from your illness (rather than for symptom control or pain relief).
- Any hospice provider who was not recommended by the hospice medical team. The hospice provider you choose must provide you with hospice care. The hospice team must provide or organize all your care for your terminal illness. Unless you switch hospice providers, you won’t be able to receive the same type of hospice care. If you’ve chosen your normal doctor or nurse practitioner to be the attending medical professional who helps supervise your hospice care, you can continue visit him or her.
- Board and lodging. If you receive hospice care at home, or if you live in a nursing home or a hospice inpatient facility, Medicare does not fund room and board. Medicare will fund your stay in the facility if the hospice team believes that you require short-term inpatient or respite care services that they provide. A nominal co-payment may be required for the respite stay.
- Hospital outpatient care (such as in an emergency room), hospital inpatient care, or ambulance transportation, unless it’s planned by your hospice team or unrelated to your terminal disease and related conditions.
