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Medicare Hospice Benefit

Topic Overview

Medicare is a health insurance program for people 65 years of age and older, for some people younger than 65 who have disabilities, and for people with long-term (chronic) kidney failure treated with dialysis or a transplant. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) of the United States government.

The Medicare hospice benefit is described in Part A, which talks about hospital insurance. Part A benefits provide coverage for hospitals, nursing facilities (but not custodial or long-term care), some home health care, and hospice. People (including a spouse) who paid Medicare taxes while they were working are eligible for Part A benefits. A monthly payment, or premium, is not required for Part A benefits.

Eligibility

The Medicare hospice benefit provides coverage for services related to a life-limiting illness. Hospice care is covered under Medicare Part A benefits. You must meet all of the following criteria to be eligible for the Medicare hospice benefit:

  • You must be eligible for Medicare Part A benefits.
  • Your doctor and hospice medical director must certify that you have a life-limiting illness and are likely to live 6 months or less if your illness follows a normal course.
  • You must sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your life-limiting illness. (Medicare will still cover services for any health problem that is not related to your life-limiting illness.)
  • You must receive care from a hospice approved by Medicare.

Covered services

Medicare pays the hospice program a daily (per diem) rate that is intended to fully cover most services related to a life-limiting illness, including:

  • Hospice nursing care in your home. This includes intermittent visits by a nurse to check on your symptoms. Nurses are also available 24 hours a day, 7 days a week to visit if you need help. Live-in nursing care is not covered.
  • Medical supplies and equipment, such as a wheelchair, hospital bed, or incontinence pads.
  • Medicines for symptom control and pain relief. You will have to pay no more than $5 for each prescription drug and other related products.
  • Visits to your doctor to help manage your life-limiting illness.
  • Intermittent homemaker and home health aide services. The service of a live-in homemaker or home health aide is not covered.
  • Physical, occupational, or speech therapy, if needed because of your life-limiting illness.
  • Dietary counseling.
  • Visits from a counselor or social worker.
  • Spiritual care, if desired.
  • Visits from trained volunteers. Volunteers are available on a short-term basis to provide companionship, to help with your care, or to run errands.
  • Short-term respite care so your caregiver can rest or take some time off (you may need to pay a small copayment).
  • Temporary hospitalization, if needed, to help manage symptoms that cannot be controlled at home.
  • Counseling (called bereavement care) for your family, friends, and caregivers following your death.

If your condition changes so that hospice is no longer appropriate, you can get your previous Medicare benefits reinstated. You can also re-apply for hospice benefits at a later time if needed.

For more information

The Centers for Medicare and Medicaid Services (CMS) of the United States government manages the Medicare hospice benefit. You may call toll-free (1-800-633-4227) or visit its Web site at www.cms.gov for more information.

Credits

By Healthwise Staff
Anne C. Poinier, MD - Internal Medicine
Shelly R. Garone, MD, FACP - Palliative Medicine
Last Revised July 6, 2012

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