Hospice gives comfort, dignity, and support when a cure is no longer the goal. Here's exactly what Medicare pays for and how to access it.
What does the Medicare hospice benefit cover?
Medicare's hospice benefit covers nearly everything related to your terminal illness: doctor and nursing services, medical equipment (like hospital beds and wheelchairs), supplies, prescription drugs for pain and symptom control, hospice aide and homemaker services, physical and occupational therapy, social work, dietary counseling, grief support for your family, and short-term inpatient and respite care. Care is delivered by a coordinated team wherever you call home. Under the original Medicare hospice benefit, you pay nothing for these services. The only possible charges are up to $5 per outpatient prescription for symptom management and 5% of the Medicare-approved amount for inpatient respite care, according to Medicare.gov.
Who is eligible for Medicare hospice coverage?
To qualify for Medicare's hospice benefit, you must be enrolled in Medicare Part A, your hospice doctor and regular doctor must certify you are terminally ill with a life expectancy of 6 months or less if the illness runs its normal course, and you must sign a statement choosing hospice care instead of curative treatment for your terminal illness. You can still get Medicare coverage for health problems unrelated to your terminal condition. Importantly, hospice is not a one-way door: if you live longer than 6 months, you can keep getting hospice care as long as the hospice medical director recertifies you, and you can stop hospice and return to curative care at any time.
What are the 4 levels of hospice care?
Medicare defines four levels of hospice care, and your team moves you between them based on need. Routine home care is the most common, with the team coming to wherever you live. Continuous home care provides round-the-clock nursing during a medical crisis to keep you home. General inpatient care manages severe symptoms, like uncontrolled pain, that can't be handled at home, in a facility. Inpatient respite care gives your family caregiver a break by caring for you in a Medicare-approved facility for up to 5 consecutive days. Each level is covered by Medicare, with only the small respite coinsurance applying.
How is hospice different from palliative care?
Palliative care and hospice both focus on comfort, but they aren't the same. Palliative care can start at any stage of a serious illness, alongside treatments meant to cure or control the disease, no matter your prognosis. Hospice is a form of palliative care specifically for people who are terminally ill with about 6 months or less to live and who have chosen comfort over curative treatment. Put simply: all hospice is palliative care, but not all palliative care is hospice. Medicare covers hospice fully under Part A; palliative care is typically covered under Parts A and B like other medical services, with standard cost-sharing that a Medigap policy can help offset.
How do you start hospice care under Medicare?
Starting hospice begins with a conversation. Talk with your doctor about whether hospice is appropriate, then choose a Medicare-approved hospice provider. Your doctor and the hospice medical director certify your eligibility, you sign a consent and election statement, and the hospice team builds a personalized care plan, often within 24 to 48 hours. You can choose any Medicare-certified hospice; you're not locked into one and can switch once per benefit period. If you're unsure how your Medicare, Medigap, or Medicare Advantage plan fits in, call 1-800-MEDIGAP. Our licensed specialists explain your coverage in plain English so your family can focus on what matters most.