Hospice services offer comforting end-of-life care provided by a large team of specially trained professionals. It can offer valuable benefits to the whole family, but costs do tend to stack up quickly. How does one cover the expenses? Medicare can be a great, reliable option for help covering any cost directly related to your loved one’s hospice care, no matter the care setting. Find out if your loved one is eligible to receive Medicare’s hospice coverage and learn more about how that coverage works.

Key Takeaways

Medicare Parts A and B generally pay for eligible seniors’ hospice care. Certain requirements must be met, and covered services must be directly related to your loved one’s terminal illness and its symptoms.
Medicare will not pay for a handful of specific services. These include curative treatment and prescriptions, but there are other ways to fill this gap in coverage.
Hospice providers must be Medicare-certified. You can find help with identifying in-network providers through Medicare’s staff.
Medicare sends funds directly to your hospice provider. Your loved one will just need to continue paying their monthly premiums.

Will Medicare pay for the costs of hospice?

If you’re beginning to search for hospice for a parent or loved one, find some peace in knowing that, yes, many hospice-related expenses can be covered by Original Medicare (Parts A and B), provided specific criteria are met. Depending on your loved one’s health condition, Medicare can cover expenses such as nursing care and doctor’s services, any necessary medical equipment or supplies, various therapies and counseling services, any prescribed medications, and other services needed to manage your loved one’s terminal illness and symptoms^[01]

How does Medicare’s hospice coverage work?

Upon beginning hospice care, your loved one’s doctor will devise a care plan and connect your family with a hospice care team consisting of nurses, doctors, counselors, therapists, personal care aides, and sometimes volunteers. The hospice nurse and doctor are typically on call 24/7 so your family can have access to care and support whenever it’s most needed.

Once hospice treatment is underway, Original Medicare will cover all costs related to your loved one’s terminal illness. As long as they pay their premiums, Medicare will directly pay the hospice provider for the care costs with minimal out-of-pocket costs, if any.

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Eligibility requirements

To qualify for the Medicare hospice benefit, your loved one will need to meet the following requirements:

They must be enrolled in Medicare Part A (hospital insurance).
The hospice provider must be approved by Medicare.
Their doctor has certified that they’re terminally ill with a life expectancy of six months or less.
They’ve agreed to accept comfort care over curative treatment and have signed a document saying so.^[01]

Where can my loved one receive hospice care?

Medicare can cover hospice costs in any care setting, including in-home care, assisted living, memory care, nursing home, or inpatient hospice facilities. However, Medicare likely won’t cover room and board in a facility care setting. If your family decides care in a facility would be best suited for your loved one, then their hospice care team must be the ones to make the arrangements. If your loved one goes to a hospital or other facility without consulting the hospice care team first, they may be responsible for the entire cost of care.^[02]

If your loved one is solely relying on Original Medicare to cover their hospice costs, there are some restrictions you’ll need to be aware of. Medicare’s hospice benefit won’t cover the following items:

Curative treatment. Rather than curing an illness, hospice is meant to be used as comfort care and symptom management as the patient approaches the end of their life. However, every patient has the right to stop hospice at any time if they decide they’d rather try treatment to cure their illness.
Prescriptions for anything other than the terminal illness or related conditions. While these aren’t covered by the hospice benefit, your loved one may instead be able to get coverage for their prescriptions through Medicare Part D, which is prescription drug coverage.
Room and board expenses. The hospice benefit won’t cover room and board in a facility unless your loved one’s hospice team determines short-term inpatient care is necessary. In this case, Medicare will cover the cost of the stay, but there may be a copayment.
Hospital care. Unless deemed necessary by the hospice care team, the hospice benefit won’t cover inpatient or outpatient hospital care, care provided in an emergency room, or ambulance transportation.
Any care provided by someone not approved by the hospice team. Your loved one’s hospice medical team must arrange all the care your loved one receives for their illness and any related conditions.^[01]

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Hospice care through a Medicare Advantage Plan or Medigap policy

Fortunately, there are ways to fill gaps in coverage, and that’s through a Medicare Advantage plan, sometimes called Medicare Part C, or a Medicare Supplemental Insurance plan, also called a Medigap policy. Medicare Advantage plans and Medigap policies can help provide additional coverage for things outside of Original Medicare, including prescription medications or health problems that aren’t part of your loved one’s terminal illness. However, there may be some copays or deductibles.

Medicare Advantage Plans are offered by Medicare-certified private companies and must follow rules set by Medicare. If your loved one was enrolled in a Medicare Advantage Plan prior to their hospice care and wishes to remain on that plan, they can. They’ll just need to continue paying their premiums.

If your loved one chooses to stay in their Medicare Advantage Plan, the plan will still cover the following:

Any additional medically necessary services, such as dental or vision care
Services for health issues unrelated to their terminal illness
Prescription medications (This is only an option if their plan offers Medicare Part D, the prescription drug benefit)

A Medicare Supplemental Insurance plan, or Medigap policy, is insurance coverage sold by private companies that can help cover hospice costs for medications and respite care, as well as health care costs for health issues unrelated to your loved one’s terminal illness.^[01]

How does Medicare pay for hospice?

Medicare will pay your loved one’s hospice provider directly with no required deductible. The payments your loved one may still be responsible for include the following:

Monthly insurance premiums for Medicare Parts A and B
A copayment of no more than $5 (per prescription) for any prescription drugs
If respite care is utilized, there will be a fee of 5% of the cost of inpatient respite care, and the provider must be Medicare-approved ^[01]

Be sure to talk to your loved one’s doctor about how much each item or service will cost. Amounts can vary depending on whether your parent has another type of insurance. The type and location of the facility where any testing or services are performed can also affect the amount you pay.

How long will Medicare cover hospice-related costs?

As you now know, your loved one may only begin hospice care once their doctor determines they have six months or less to live. But, because it’s so difficult to determine someone’s exact life expectancy, there’s some leeway. The Medicare hospice benefit is broken down into two 90-day benefit periods. If needed, these are followed by an unlimited number of 60-day benefit periods.

In other words, if your loved one surpasses the six-month cut-off, they can still receive covered hospice care as long as their doctor continues to certify that they’re still terminally ill. This recertification will then be required prior to each subsequent 60-day benefit period. Thanks to this process, some terminally ill patients can sustain their hospice care for several more months or even years, if needed.

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References

Centers for Medicare & Medicaid Services. (2023, March) Medicare Hospice Benefits .
Medicare.gov. How hospice works.

Meet the Author

Grace Styron

Grace Styron is a writer at OurParents specializing in assistive technology, memory care, and home care. Before writing about healthy aging, she worked for an online women’s lifestyle magazine and as a grant writer for a nonprofit regenerative permaculture farm in Virginia. She earned her bachelor’s degree from Missouri State University.

Edited byDanny Szlauderbach

Reviewed byDenise Lettau

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Does Medicare Cover Hospice?