Medicare Coverage of Hospice Care

Some of the costs of hospice care are inevitably paid with personal family assets and insurance. These days, however, the vast majority of hospice care is paid for by Medicare, the federal health insurance program that covers some younger people with disabilities and adults who:

• are age 65 and older
• receive Social Security payments, or
• are diagnosed with end-stage renal disease.

Medicare Part A, which generally covers hospital costs, has covered hospice care since 1983. (To learn more about Medicare, see Nolo's Medicare and Medicaid area.)

When Medicare Will Pay for Hospice Care

Medicare Part A will only pay for care provided by a Medicare-certified program and does not allow patients to receive care from more than one hospice program at the same time. That may mean, for example, that a person who was regularly receiving home health care from a specific agency may have to receive it instead from a more complete hospice service that offers the same type of care.

In addition, to get hospice care coverage by Medicare Part A:

• a doctor and the hospice medical director must verify that the patient has a terminal illness and probably has less than six months to live, and
• the patient must sign a statement choosing hospice care instead of standard Medicare-covered benefits -- although Medicare will continue to cover health problems that are not related to the terminal illness.

If hospice care will be received at home, caregivers should find out the amount of services that will be provided before agreeing to give up standard medical benefits; sometimes nursing and other services provided in the home environment are quite limited, such as one hour every other day.

Hospice Services Covered by Medicare

Medicare pays a fixed amount for most hospice services, including:

• nursing services (amount depends on patient's needs)
• medical equipment, such as wheelchairs or walkers
• medical supplies, such as bandages and catheters
• drugs for symptom control and pain relief
• short-term hospital care, including respite care to give caregivers a break from their duties
• home health aide and housekeeping services
• physical, occupational, and speech therapy
• social worker services
• nutritional counseling, and
• grief counseling for both the patient and the family.

Patients may be personally responsible for paying for:

• the difference between what Medicare will pay and what the hospice service charges
• treatments designed to cure a terminal illness
• treatment or services not related to comfort care, and
• room and board -- except for temporary respite care.

Length of Time Covered by Medicare

Medicare generally covers a total of 210 days of hospice care, broken into two 90-day periods of benefits, followed by a 30-day period. Each of the periods may be extended, but only when a doctor recertifies that the patient's condition remains terminal. In some rare circumstances, coverage may be extended indefinitely.

For more information on hospice, including detailed information on options for paying for it, see Long-Term Care: How to Plan & Pay for It, by Joseph L. Matthews (Nolo).