When Susan’s mother was terminally ill, her doctors recommended hospice care. It would help keep…
The government health-insurance program can help pay for comfort-care toward the end of life.
If you or a loved one are on Medicare, you probably know it covers many medical services. Depending on the type of Medicare plan you’ve chosen, the program can help pay for your doctor visits, hospitalizations, prescription drugs and more.
But what if you are terminally ill, and you no longer want aggressive treatment? How will you maintain your comfort and dignity — and perhaps even remain at home for your last weeks and months? You may also have questions when it comes to paying for hospice care.
That’s where hospice comes in. Hospice is a special kind of care for people near the end of life, which focuses on enhancing comfort and quality of life, rather than attempting to “cure” the person.
But what happens when it comes to dying for hospice care? The big question becomes: Is hospice care covered by Medicare?
For many people, the answer is “yes.” Medicare has certain rules about who qualifies for coverage of hospice care, which are explained below.
Hospice is a holistic form of care that addresses one’s physical, emotional, social, and spiritual needs, as defined by the patient and family. It enables people to spend time focusing on what matters most to them, and often allows them to avoid hospitalization at the end of life.
Care is given where the patient lives, such as the family’s home, assisted-living facility or nursing home. Patients who need intensive, 24-hour support to relieve pain or other symptoms can receive care in specialized, inpatient hospice centers.
Hospice provides benefits to the family, too, including advice and support on caring for their loved one, on-call access to the hospice team, respites from caregiving, and grief support.
Care is provided by a specially trained team, including hospice physicians, nurses, certified home health aides, social workers, spiritual support counselors, grief counselors, various types of therapists, and trained volunteers. Services can include physical care, counseling, prescription drugs, equipment, and supplies for the person’s illness and related conditions. For more details on hospice services covered by Medicare, see the list below.
Medicare will pay for hospice care for patients who have Medicare Part A (Hospital Insurance) or Part C (Medicare Advantage Plans) and meet the following conditions:
In addition, the hospice provider you choose must be Medicare-approved, in order to receive Medicare coverage for hospice care.
Medicare covers hospice care for specific time periods. It pays for two consecutive 90- day periods, followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical director and your doctor must recertify that you’re terminally ill (with a life expectancy of six months or less), so you can continue to receive hospice care. You have the right to change hospice providers once during each benefit period.
If you’re not sure what type of Medicare coverage you have, here are ways to find out:
Call 1-800-MEDICARE (1-800-633-4227).
The Medicare hospice benefit generally covers everything needed by a terminally ill person and their family. It provides:
Depending on your terminal illness and related conditions, your hospice team will create a plan of care that can include:
If your usual caregiver (such as a family member) needs a break from caregiving, you can receive inpatient respite care in a Medicare-approved facility. The facility can be an inpatient hospice center, hospital, or nursing home. Your hospice provider will make these arrangements if you request them.
If you have any health problems that are not part of your terminal illness or related conditions, Original Medicare will still pay for covered hospice benefits for such needs. However, this situation is rare.
You always have the right to stop hospice care at any time, for any reason. If you stop your hospice care, you’ll get the type of Medicare coverage you had before you started hospice – such as treatment to cure the terminal illness.
You can return to hospice care at any time, as long as you meet the eligibility requirements described above.
If you’re covered by Medicare’s hospice benefit, you will only pay a small portion of the costs of your care. According to Medicare, you are only responsible for:
Also, if your Medicare Advantage Plan or other Medicare health plan covers extra services that Original Medicare doesn’t cover (such as dental and vision benefits), your plan will continue to cover these extra services while you’re on hospice care (as long as you continue to pay your premium).
People who are on Medicare have certain guaranteed rights. For instance, if you are told you no longer qualify for hospice care because your condition has improved—but you disagree—you can ask Medicare to review your case.
Your hospice provider is required to give you a notice that explains your right to an expedited (fast) review by an independent reviewer contracted by Medicare, called a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). If you don’t receive this notice, make sure to ask for it. The notice provides your BFCC- QIO’s contact information and explains your rights.
You can also visit Medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your BFCC-QIO. TTY users should call 1-877-486-2048.
In addition, if you pay out-of-pocket for an item or service your doctor ordered, but your hospice provider refuses to give it to you, you can file a claim with Medicare. If your claim is denied, you can file an appeal.
For more information on appeals, visit Medicare.gov/appeals or call 1-800-MEDICARE.
Here are some additional resources to learn more about Medicare and paying for hospice: