Does Medicare Cover Hospice?

Medicare

“Does Medicare cover hospice?” The answer is, “It depends.”  Hospice care is often a crucial service that helps keep a person comfortable during an advanced illness. It is a form of palliative care geared toward helping the patient find relief from the stress and the many symptoms of their illness. With the stated goal of improving the patient’s and their family’s quality of life, hospice services are available for in-home care as well as hospital and nursing facility care.

Length of Time for the Services

Medicare only covers hospice care if it is requested by the doctor or the nursing home for a short period of time of 6 months or less. At this point, it is considered to be end of life care. It does not cover long-term care. If you are expected to need special care for a period of longer than 6 months, it is considered to be palliative care and comes under different requirements.

Conditions for Qualification

Medicare does contribute to in home care, hospice, outpatient hospice care, or for a short time in a nursing facility if you meet certain qualifications.

  • You have recently been in the hospital for 3 days.
  • Within 30 days of your hospital stay, you have moved to a nursing home approved by Medicare
  • You need skilled care not delivered by custodial persons.
  • You are not expected to require the hospice services for more than 6 months.

Amount Medicare Pays for Hospice Care

If you meet the requirements stated by Medicare, It will pay for the first 20 days of your care. That includes in-home hospice care, outpatient hospice care, and services delivered in the nursing home. During that 20 days, Medicare will pay 100% of the cost. For the next 80 days, you will have to pay the first $140 of each day’s services. If you are in the facility for more than 100 days, you pay full costs.

Medically Necessary Care

If your doctor recommends hospice care, Medicare will cover the medications you receive for that illness and for pain relief. You will also receive medical services if the hospice care is provided by a Medicare-approved provider.

Additional support services, such as grief counseling and inpatient care for the purpose of relieving the primary caregiver are only available through Medicaid in the form of hospice.

Levels of Hospice Care

Medicare outlines 4 levels of hospice care that it will cover:

  • Routine home or nursing home care, which includes physician, nursing, home health aide, counseling, medications, medical equipment and supplies, therapy, and lab work related to the terminal condition.
  • Continuous care in the home, which requires round-the-clock medical care. This is often re-evaluated every day.
  • Continuous care in a facility, which can be a hospital, nursing home, or a hospital’s hospice unit.
  • Respite care, which is for the family. This helps to relieve the caregivers who are often placed in stressful situations while caring for their relative in hospice. This is only available for 5 days.

With doctor or nursing facility referrals, Medicare will offer some non-medical end of life services such as respite care and grief counseling.

To compare providers online with a specialist, call a Grace Specialist at 877-273-0110. We can walk you through hospice options based on your preferences and help find the care you or your loved one needs.

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