Medicare's hospice benefit is primarily home-based and offers end-of life support for your physical, emotional, and other needs.
The hospice benefit covers a wide range of medical supplies, homemaker, and social services.
To elect Medicare hospice, you must have a doctor certify you have a terminal illness with a life expectancy of under six months.
Hospice is an end-of-life pain management and comfort care program for those with a terminal illness.
Medicare's hospice benefit is primarily home-based and offers end-of life palliative treatment, including support for physical, emotional, and other needs. The goal of hospice is to help you live as comfortably as possible, not to cure a terminal illness.
What is covered under Medicare's hospice benefit?
- Skilled nursing services: services performed by or under the supervision of a licensed or certified nurse to treat an injury or illness. Services include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
- Skilled therapy services: physical, speech, and occupational therapy services to manage your symptoms or help maintain your ability to function and carry out activities of daily living (eating, dressing, toileting). These services are performed by or under the supervision of a licensed therapist.
- Hospice aides and homemaker services: full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, and some homemaker services (changing the bed, light cleaning, and laundry)
- Medical supplies: full coverage of certain medical supplies, such as wound dressings and catheters
- Durable medical equipment (DME): full coverage of equipment needed to relieve pain or manage your terminal condition
- Respite care: short-term inpatient stays for the beneficiary that allow their caregiver to rest. This coverage includes up to five consecutive inpatient days at a time. You will pay a copayment of no more than 5% of the Medicare-approved amount for each day.
- Short-term inpatient care: care at a hospital, skilled nursing facility , or hospice inpatient facility if a medical condition calls for a short-term stay for pain control or acute or chronic symptom management. This is only covered if care cannot feasibly be provided in another setting
- Medical social services: full coverage of services ordered by a doctor to help with social and emotional concerns related to an illness. This may include counseling and/or help finding resources in your community
- Prescription drugs related to pain relief and symptom control. You will pay a $5 copay
- Spiritual or religious counseling
- Nutrition and dietary counseling
How do I elect hospice?
To elect hospice, you must:
- Be enrolled in Medicare Part A
- Have a hospice doctor certify that you have a terminal illness
- A terminal illness means you have a life expectancy of six months or less
- Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
- Receive care from a Medicare-certified hospice agency
If you are interested in Medicare's hospice benefit, you should:
- Ask your doctor whether you meet the eligibility criteria for Medicare-covered hospice care.
- Ask your doctor to contact a Medicare-certified hospice on their behalf.
- Be persistent! There may be several Medicare-certified hospice agencies in your area. If the first one you contact is unable to help you, you should contact another.
Once you have found a Medicare-certified hospice:
- The hospice medical director (and/or your regular doctor if you have one) will certify that you are eligible for hospice care.
- You must sign a statement electing hospice care and waiving curative treatments for your terminal illness.
- Your hospice team must consult with you (and your primary care provider, if you wish) to develop a plan of care.
- Your team may include a hospice doctor, a registered nurse, a social worker, and a counselor.
Currently, once you choose hospice, all your hospice-related services will be covered under Original Medicare, even if you are enrolled in a Medicare Advantage plan.
This content was developed for NCOA with assistance from the Medicare Rights Center.