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In short Who qualifies What the benefit covers What it costs What Medicare does not cover under hospice You can change your mind Common questions SourcesHospice is comfort care for people with an illness that cannot be cured, and Medicare Part A covers it fully: you pay nothing for covered hospice services from a Medicare-approved provider. Medicare does not pay room and board in a nursing home or hospice facility. The few costs that exist are small: up to $5 per outpatient prescription for pain and symptom relief, and 5% of the cost for short-term respite care.
Who qualifies
You qualify with Part A when your hospice doctor and your regular doctor, if you have one, certify that you are terminally ill with a life expectancy of 6 months or less, you accept comfort care instead of treatment meant to cure the illness, and you sign a statement choosing hospice. Care can continue past 6 months as long as the hospice medical director or doctor recertifies that you are still terminally ill.
What the benefit covers
Once you choose hospice, the benefit is meant to cover everything you need for the terminal illness and related conditions: nursing and medical care, medications for symptom control and pain relief, medical equipment and supplies, aide and homemaker services, social services, and grief support for you and your family. You and your family work with the hospice team to set up the plan of care.
What it costs
From a Medicare-approved hospice provider, you pay nothing for covered hospice services. The exceptions: a copayment of up to $5 for each outpatient prescription for pain and symptom management, and up to 5% of the Medicare-approved amount for inpatient respite care, which is short-term care that gives caregivers a rest. Original Medicare still covers health problems unrelated to the terminal illness, with the usual deductibles and coinsurance.
What Medicare does not cover under hospice
Once the hospice benefit starts, Medicare stops covering treatment intended to cure the terminal illness, drugs meant to cure rather than comfort, care from providers the hospice team did not arrange, and room and board in a nursing home or hospice facility. If the hospice team decides you need short-term inpatient or respite care, they arrange the stay and Medicare covers it; hospital or ambulance care the team did not arrange can leave you paying the full cost.
You can change your mind
You can stop hospice care at any time and return to regular Medicare coverage, and you can restart hospice later as long as you still qualify. You also have the right to change your hospice provider once during each benefit period. If your illness improves or goes into remission, you no longer have to stay on hospice.
Common questions
Does choosing hospice mean giving up all treatment?
It means stopping treatment aimed at curing the terminal illness. Care for comfort continues fully, and Original Medicare still covers unrelated health problems. You can leave hospice and resume curative treatment at any time.
Is hospice only for the last days of life?
No. People qualify with a life expectancy of 6 months or less, and care continues as long as a doctor recertifies eligibility. Many families say they wish they had started earlier.
Where does hospice happen?
Usually at home. It can also happen in a nursing home or hospice facility, though Medicare does not cover room and board there. Short-term inpatient stays arranged by the hospice team are covered.
Can Pymander answer questions during a serious illness?
Pymander can explain terms, help families prepare questions for the care team, and answer everyday health questions. It does not provide end-of-life care or manage treatment. Pymander is available in all 50 states.