Does Medicare cover hospice care?

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Dear Connie,

My husband is 74, on Original Medicare, and was recently diagnosed with a terminal illness. We’ve been married for 36 years, and it’s a lot to take in. I’m also worried about being able to care for him on my own. We don’t have family members close by, so I feel very much on my own.

Is it possible to get 24-hour hospice care? And does Medicare cover hospice?

Cherishing the time that remains,
Sue from Miami, Florida

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Dear Sue,

We’re sorry to hear that your dear husband requires hospice care. We understand that this is an incredibly challenging time for many reasons. I hope I can help relieve some of your worries and answer your questions. I’ll do my best to explain what Medicare does and doesn’t cover concerning hospice care.

First, a hospice program’s focus is on palliative care. The hospice care team will focus on your husband and family’s quality of life. Palliative care can help with your husband’s physical, intellectual, emotional, social, and spiritual needs. It will also support your family’s independence, access to information, and your husband’s decision-making ability.

The family usually provides hospice care with intermittent in-home support and access to a 24-hour on-call nurse. That means outside of family care; someone may visit a few times a week, up to daily, for visits that last less than an hour. During these visits, they’ll check on your husband, his medication needs, and any other symptoms.

Agent tip:

“Caring for your husband may take a high physical and emotional toll on you and your family. Original Medicare covers respite care, which gives caregivers a rest for up to five consecutive days and may be done occasionally.“

Caring for your husband may take a high physical and emotional toll on you and your family. Understandably, family caregivers may need more of a break than nurses, aides, or volunteers can provide. In these instances, you may need to check your husband into a 24-hour hospice care home.

The answer to whether Medicare covers hospice care, and 24-hour hospice care, is yes and no. To receive Medicare hospice benefits, your husband must meet eligibility requirements.

I’m going to assume that your husband’s doctor has certified that he has a terminal illness with a life expectancy of six months or less. If he hasn’t been certified for this. His eligibility for hospice care depends on that.

Your husband is eligible for Medicare hospice benefits if:

• He is enrolled in Original Medicare Part A.
• He agrees to comfort care instead of care to cure the disease.
• He’s signed a statement choosing hospice care instead of other Medicare-approved benefits to treat his terminal illness and related conditions.
• He receives hospice care from a Medicare-approved facility.

If he is eligible based on these criteria, then yes, Original Medicare will cover Medicare-approved hospice services and care.

Medicare-approved hospice care and services could include:

• All services and items needed for pain relief and symptom management.
• Medical, nursing, social services, and spiritual and grief counseling.
• Durable Medicare Equipment (DME) for pain relief and symptom management.
• Hospice aide and homemaker services.
• Physical, occupational therapy, and dietary counseling.
• Short-term inpatient care when necessary for managing pain or symptoms.
• Short-term respite care.

During hospice, your husband would need to continue paying his Medicare Part A and Part B premiums, and there may be a copayment of up to $5 for each outpatient prescription to manage pain and symptoms. There is no copayment or coinsurance for hospice care, but you should ensure that any treatment received is covered by hospice. There are some exclusions.

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24-hour hospice care in an inpatient facility is also covered – if coordinated through a Medicare-certified hospice agency and hospice doctor. You should check with a Medicare-certified hospice agency because they often have a particular home that it works with and is Medicare-approved.

He may need to pay 5% of the Medicare-approved amount for inpatient respite care. Respite care gives caregivers a rest for up to five consecutive days and may be done occasionally.

If you want in-home 24-hour hospice care, that would likely be provided by private-pay home care. If you would prefer that 24-hour care is provided in-home, Medicare benefits usually won’t cover that. However, hospice agencies can help you coordinate that care.

I hope this information helps you understand how your husband can receive the care he needs and how you can receive support as well. We know you’re going through a difficult time, and we are here to help.

At Connie Health, we help you throughout your Medicare journey. If you have additional questions or need support, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711). We’d be happy to help in any way we can.

Sources

Hospice care.

Medicare Hospice Benefits.

Last updated: February 23, 2023

Frequently Asked Questions

How long will Medicare pay for hospice care?

Medicare will pay for hospice care as long as the hospice medical director or other hospice doctor certifies that the patient is terminally ill.

Hospice life expectancy is 6 months or less, but if you live longer than 6 months hospice care will continue as long as the patient is recertified as terminally ill.

To avoid costly out-of-pocket costs, ensure that Medicare Part A and B premiums continue to be paid throughout hospice care.

Does Medicare cover 24 hour hospice care?

Medicare covers 24-hour hospice care for caregiver respite – up to five consecutive days and only occasionally. 24-hour hospice care in an inpatient facility is covered when coordinated through a Medicare-certified hospice agency and hospice doctor. Check with a Medicare-certified hospice agency because they often have a particular home that they work with and is Medicare-approved.

Respite care may cost a 5% coinsurance of the Medicare-approved amount for 24-hour inpatient respite care.

Original Medicare does not cover 24-hour hospice care outside of respite.

Does Medicare cover hospice in-home care?

Hospice in-home care is usually provided by the family, with occasional in-home support and access to a 24-hour on-call nurse. This means that outside of family care; someone may visit a few times a week, up to daily, for visits that last less than an hour. During these visits, the care provider will check on the patient, medication needs, and any other symptoms.

During hospice, Medicare Part A and B premium payment is required and there may be a copayment of up to $5 for each outpatient prescription to manage pain and symptoms. There is no copayment or coinsurance for hospice care, but you should ensure that any treatment received is covered by hospice. There are some exclusions.