Insurance can be confusing – but Medicare has clear guidelines for the compassionate care provided through hospice services. Hospice care is not an everyday service or experience, so it’s normal to have many questions about what to expect.

Medicare is the nation’s largest health insurance program, offering coverage to people over the age of 65, or to those under 65 who have been totally and permanently disabled for at least ten years. Below is an outline of everything you need to know about coverage for hospice.

Your Guide to Medicare and Hospice Care 600

How much of hospice care is covered by Medicare?

Medicare covers everything you need related to a terminal illness and related conditions once the hospice benefit period starts – there is no deductible. Care must be provided by a Medicare-approved hospice provider. Services may include:

  • Physician services
  • Nursing care
  • Social services to connect you with community resources
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Prescription drugs
  • Hospice aide and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care (for pain and symptom management)
  • Short-term respite care in a Medicare-approved facility to help family caregivers take a break

What is required for coverage?

If you have Medicare Part A and meet the following conditions, you can get hospice care:

  • Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (you’re expected to live six months or less).
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. Note: Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have six months or less to live.

A doctor will determine if the above conditions are met prior to referring you to hospice. Then, the first two benefit periods last 90 days each, followed by an unlimited number of 60-day periods. To continue hospice care for each period, a doctor must confirm that you are terminally ill. You always have the right to stop hospice care for any reason, and you can go back on hospice at any time.

What would I need to pay?

While Medicare covers everything you need related to your terminal illness, there are a few costs to expect:

  • Your monthly Medicare Part A and Part B premiums
  • A copayment of up to $5per prescription for outpatient drugs for pain and symptom management
  • 5 percent of the Medicare-approved amount for inpatient respite care if your loved ones need to take a break from caring for you at home

Original Medicare will cover services for any health problems not related to your terminal illness.

A plan in two parts

Medicare is made up of two components. Part A, which is usually available at no cost to you, helps pay for inpatient hospital care as well as hospice. Part B, which usually requires a monthly premium, helps pay for doctor’s services, outpatient hospital care, some medical services and some home healthcare.

Part A at a glance:

  • You are eligible for Part A when you turn 65 if you or your spouse has paid in enough quarters while working.
  • If you did not pay Medicare taxes, you may be able to buy Part A.

Part B at a glance:

  • You can purchase Part B when you turn 65.
  • You or another payer, such as Medicaid, pay a monthly premium.
  • Part B also includes some hospice provisions.
  • Part B covers outpatient hospital visits and some medical services that Part A does not.

How to find coverage

Anyone can make a referral to hospice care; you don’t have to wait for a doctor. Call 1.866.KINDRED (1.866.546.3733) 24 hours a day, seven days a week to speak with a Registered Nurse who can help determine if hospice care may be an option for you or a loved one and find services in your area. We are here to answer your hospice care questions.

You can also call 1-800-MEDICARE (1-800-633-4227) to find the number of your state hospice organization. TDD/TYY users can call 1.877.486.2048.

By Dave Inman