Hospice Coverage Under Medicare
Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness.
To elect hospice, you must:
- Be enrolled in Medicare Part A
- Have a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or less
- Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
- And, receive care from a Medicare-certified hospice agency
Once you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice also should cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to your terminal condition.
The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods, pending recertification by a doctor.
If you are interested in Medicare’s hospice benefit:
- Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.
- Ask your doctor to contact a Medicare-certified hospice on your behalf.
- Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, contact another.
Once you have found a Medicare-certified hospice:
- The hospice medical director (and your doctor if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
- Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care. Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.
© Medicare Rights Center. Used with permission.
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