Hospice Care Covered under Medicare - dummies

Hospice Care Covered under Medicare

Copyright © 2014 AARP. All rights reserved.

Medicare began covering hospice care in 1983, and it’s one of the most generous benefits that the program provides — at little cost to terminally ill patients or their caregivers. Patients who choose hospice care are offered a full range of medical and support services, most often in their own homes.

There may come a time when a treatment intended to cure a serious illness stops working effectively or is more than the patient can bear. Hospice care offers an alternative in the last days or months of life. It focuses not on trying to cure the disease but on providing as much comfort as possible — medical, social, emotional, and spiritual — during the time left.

It also allows them to be cared for temporarily in an inpatient facility, such as a hospital or nursing home, if their regular caregivers need a break.

To qualify for the hospice benefit, you must meet all these conditions:

  • You must choose to receive hospice care and give up treatments intended to cure your terminal illness.

  • Your doctor and the medical director of a hospice program must certify that you probably have less than six months to live.

  • You must enroll in a hospice program that Medicare has approved.

  • You must have Medicare Part A hospital insurance.

If you qualify, Medicare pays in full — 100 percent — for a wide range of services, including

  • Medical and nursing care, plus round-the-clock on-call support

  • Medical equipment and supplies

  • Homemaker and home health care services

  • Physical therapy

  • Social worker services and dietary counseling

  • Support for your caregiver

  • Grief and loss counseling for you and your family

Your share of the cost is limited to a maximum of $5 per prescription for drugs used to control the symptoms and pain of your terminal illness; and 5 percent of the cost of respite care if you’re taken into a nursing home to give your caregiver a break.

However, if you have Medigap supplemental insurance, both these costs are fully covered. (Costs related to any medical conditions other than your terminal illness are covered by Medicare Part B or Part D in the usual way.)

You’re free to stop hospice care any time you want to — and also to resume it again if that’s your wish. Coverage continues for as long as your doctor and a hospice doctor continue to certify that you’re terminally ill, even if you live longer than six months.

If your health improves and the doctors decide you no longer need hospice care, the benefit ends — though you still have the right to appeal. If your health deteriorates again, the benefit can resume.