Your Medicare Coverage

Is your test, item, or service covered?

Hospice & respite care

How often is it covered?

Hospice care is usually given in your home and includes the following services when your doctor includes them in the plan of care for palliative care (for comfort) for the terminal illness and related conditions:

  • Doctor and nursing services
  • Skilled nursing care
  • Social work services
  • Counseling services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Hospice aide or homemaker services
  • Physical, occupational, or speech language pathology therapy services
  • Drugs and medications for pain or other symptoms
  • Medical supplies and durable medical equipment
  • Short-term inpatient care for symptom relief, or for respite care
  • Any other services normally covered by Medicare to provide palliative care for the terminal illness and related conditions

Respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. You can stay in a Medicare-approved facility, such as a hospice facility, hospital, or nursing home, up to 5 days each time you get respite care.

When you choose hospice care, you've decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren't working.

Once you choose hospice care, Medicare won't cover:

  • Treatment intended to cure your terminal illness. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief).
  • Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care in an emergency room, inpatient facility care, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Who's eligible?

People with Medicare who meet all of the following conditions are covered:

  • You're eligible for Medicare Part A (Hospital Insurance).
  • Your doctor certifies that you're terminally ill and are expected to have less than 6 months to live.*
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your terminal illness.

*In a Medicare-approved hospice, nurse practitioners aren't permitted to certify the patient's terminal diagnosis, but after a doctor certifies the diagnosis, the nurse practitioner can serve in place of an attending doctor. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you're terminally ill.

Your costs in Original Medicare

  • $0 for hospice care and there is no deductible.
  • Copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
  • 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest).
  • Your usual Part B deductible and coinsurance for your doctor’s services (if your attending doctor isn't employed by the hospice).
  • Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • If you pay out-of-pocket for an item or service your doctor ordered, but the hospice refuses to give you, you can file a claim with Medicare. If your claim is denied, you may file an appeal.

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