- LoveWell Care Guide
Does Medicare Cover Hospice Care?
Yes. Original Medicare has a hospice benefit for eligible beneficiaries who elect hospice care from a Medicare-approved hospice provider. The benefit is designed to cover services related to the terminal illness and related conditions under an individualized hospice plan of care.
Coverage questions matter because families may be comparing care settings, prescriptions, equipment, and treatments. The most useful first step is understanding which services are part of the hospice plan and which remain separate.
Who Can Use the Medicare Hospice Benefit?
Medicare hospice generally requires Medicare Part A eligibility, physician certification of terminal illness with a prognosis of six months or less if the disease follows its normal course, election of hospice, and care from a Medicare-approved hospice.
The patient signs an election statement and receives information about the hospice benefit.
Services the Benefit May Cover
When included in the plan of care and related to the terminal illness, Medicare hospice coverage can include:
- Nursing and physician services
- Hospice aide and homemaker services
- Medical social services and counseling
- Medications for symptom control and pain relief
- Medical equipment and supplies
- Physical, occupational, and speech-language therapy when indicated
- Short-term inpatient care for symptom management
- Short-term inpatient respite care
- Bereavement support for loved ones
Does Medicare Pay for Room and Board?
Generally, Medicare’s hospice benefit does not pay ordinary room and board in a home, assisted living residence, or nursing facility. Certain covered inpatient hospice arrangements are different.
Families should ask about living expenses and facility charges separately from covered hospice services.
Are There Copayments?
Medicare describes generally limited cost sharing for covered hospice care, but small copayments may apply for certain outpatient medications and coinsurance may apply for inpatient respite care.
Ask the hospice to explain any expected costs and verify the current Medicare rules and individual circumstances.
What Happens to Medicare Coverage for Other Conditions?
Medicare may continue to cover medically necessary care unrelated to the terminal illness under the usual rules. Services related to the terminal illness are generally coordinated through the elected hospice benefit.
A patient with Medicare Advantage should also ask how hospice election affects plan coordination and other benefits.
Can Someone Change Their Mind?
Patients can revoke hospice election. A person may choose a different plan of care and, if eligible later, may elect hospice again. Ask the hospice to explain the implications before changing coverage arrangements.
Questions to Ask Before Admission
- Which equipment, supplies, and services related to the hospice diagnosis are included
- Which medications are covered by hospice
- Whether room and board is separate
- Whom to contact about a disputed coverage item
What Medicare Requires Before Hospice Starts
The patient must be eligible for Medicare Part A, meet the terminal-illness certification requirements, elect the hospice benefit, and receive care through a Medicare-certified hospice. The hospice should explain the election and which services fall under its plan of care.
Medications, Equipment, and Supplies
When medications, equipment, or supplies are related to the terminal illness and included in the hospice plan of care, the hospice generally coordinates their provision under the benefit. This is different from assuming that every medication or item a patient uses is automatically covered by hospice.
Before purchasing equipment or filling a prescription, ask the hospice team how it should be coordinated.
Care Unrelated to the Terminal Illness
Medicare coverage for services unrelated to the terminal illness can continue under the usual Medicare rules, subject to applicable coverage requirements and cost sharing. Determining what is related can require coordination among the hospice, clinicians, and Medicare.
Medicare Advantage and Other Coverage Questions
For patients enrolled in Medicare Advantage, hospice care is generally covered through Original Medicare under the hospice benefit, while other coverage arrangements may continue under plan-specific rules. Families should verify their exact situation with Medicare, their plan, and the hospice.
Where to Verify Benefit Details
Medicare’s official hospice information is available at https://www.medicare.gov/coverage/hospice-care. The Medicare & You handbook also explains hospice coverage and patient rights. These references should be checked at publication and whenever coverage language changes.
Frequently Asked Questions
Medicare can cover eligible hospice services delivered at home; ordinary housing and room-and-board expenses are generally not covered.
Many covered hospice services have little or no patient cost, but some limited cost sharing and noncovered expenses may remain.
The hospice benefit is not the same as continuous custodial caregiving. The hospice plan determines covered visits and medically necessary levels of care.
Potentially yes, under normal Medicare rules; coverage and coordination depend on the circumstances.
Part of the LoveWell Family
You Don't Have to Know When the Time Is Right
If you are caring for someone with a serious illness and are wondering what support may be appropriate, you do not need to have all the answers before starting a conversation. LoveWell Hospice can help you understand hospice, the evaluation process, and possible next steps.
Ask questions about hospice care or discuss whether an evaluation may be appropriate. A conversation does not obligate you to enroll.