Does Medicare Part B Cover Hospice Care

Is There A Copayment For Medicare Hospice Coverage

If you have Original Medicare, you pay nothing for hospice care. However, if you need a prescription for outpatient drugs for pain and symptom management, you will pay a copayment of up to $5 for each prescription.8

Also, if you need inpatient respite care you may pay 5% of the Medicare-approved amount. And if you live in a facility and choose to get hospice care, you may have to pay your room and board.9

Understand Your Medicare Coverage

Medicare is a health insurance program for people 65 years of age and older, for some people younger than 65 who have disabilities and for people with long-term kidney failure treated with dialysis or a transplant. Medicare is administered by the Centers for Medicare and Medicaid Services of the United States government.

How Long Does Medicare Pay For Hospice Care

Medicare pays for hospice care for as long as you need it. Hospice care is for people with a life expectancy of six months or less, but if you live longer than six months, you can still get hospice care if a hospice doctor recertifies that youre terminally ill. Your hospice doctor must recertify your need for care every 60 to 90 days.

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Who Is Eligible For Medicares Hospice Benefits

To qualify for Medicares hospice benefit, you must meet all the following conditions:

• Comfort care only. You must sign a statement choosing to receive hospice care instead of other Medicare-covered treatments intended to cure your terminal illness

• Death expected soon. Your hospice doctor and your regular doctor, if you have one, must certify that you are terminally ill and have a life expectancy of six months or less.

• Program authorized. You must enroll in a hospice program that Medicare has approved.

• Part A in place. You must have Medicare Part A hospital insurance.

You can get hospice care for up to two 90-day periods, followed by an unlimited number of 60-day periods. At the start of each period of care, your hospice doctor must confirm that you are still terminally ill for you to continue receiving hospice care benefits.

Does Medicare Cover Hospice Pay For Hospice

Original Medicare covers hospice care as long as your hospice provider is enrolled in the program and accepts Medicare. Hospice care is also covered by a Medicare Advantage plan.

If youre looking for specific answers about which hospice facilities, providers, and services are covered by Medicare, this article can help.

Once a medical doctor certifies that you have an illness that makes it unlikely that you will live longer than 6 months, Medicare will help pay for hospice care.

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What Does The Medicare Part A Hospice Benefit Not Cover

Medicare generally wonât cover any of these once you choose hospice care:

• Treatment intended to cure your terminal illness
• Prescription drugs to cure your illness
• Care from any hospice provider that wasnât set up by the hospice medical teamAll care that you get for your terminal illness must be given by or arranged by the hospice team. However, you may still be able to see your regular doctor if youâve chosen him or her to be the attending medical professional who helps supervise your hospice care.
• Room and boardMedicare doesnât cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility.
• Care in an emergency room, inpatient facility care, or ambulance transportationunless itâs either arranged by your hospice team or is unrelated to your terminal illness.

How Do You Start Hospice Care On Medicare

You may be referred to hospice care by your primary physician, specialist, or someone in your family or community. Whether you are in a facility or living at home, your physician and a hospice physician will need to verify that you qualify for hospice care before an agency can fully admit you for care.

When you agree to hospice care, youre acknowledging that you choose comfort care instead of curative care. You must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions.

Most often, your doctor or social services staff at a nursing facility will give you a list of hospices in your area, so you can choose which agency you prefer. You may receive recommendations from others in your community. You can search for and compare Medicare-certified hospice providers in your area here.

If youre enrolled in a Medicare Advantage Plan and want to start hospice care, ask your plan to help you locate a Medicare-approved hospice provider in your area.

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What Hospice Services Are Included

Medicare hospice benefits typically include:

• Medical, nursing, and social services
• Aide and homemaker services
• Pain relief and symptom management items & services, including prescribed drugs
• Grief and spiritual counseling

Medicare Part A and Part B still cover other Medicare-approved services, even if unrelated to your terminal illness.

Palliative Care Vs Hospice Care And Medicare

Medicare differentiates between palliative care and hospice care in its hospice coverage. Hospice care is deemed as end-of-life care for terminally ill patients that has no curative intent but focuses on symptom and pain management. In contrast, palliative care may include curative treatments or procedures.

Hospice care is usually end-of-life care for patients with a life expectancy of six months or less. Palliative care, on the other hand, can be pursued at any time, including during the diagnosis of an illness, in the course of treatment, or at the end of life.

The Medicare hospice benefit does not include coverage for curative prescription drugs or treatments. However, if you have Medicare Advantage or Medicare Part D, the cost of such drugs and treatment may be covered under those plans.

Medical equipment, skilled nursing care, social services, and medications for symptom and pain relief are all covered by Medicare Part A for patients in hospice care. However, for patients who need palliative care, Medicare Part B and Medicaid will cover some types of palliative care services, but copays may apply.

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What Medicare Nursing Home Coverage Am I Eligible For If I Need Long

Medicare wont pay your nursing home costs, but you still have your Part A and Part B benefits while youre in a nursing home. For example, Part B covers your doctor visits and medical therapy visits, and if you need hospital care, Part A benefits apply. If you have a Part D Prescription Drug Plan, the medications you take in the nursing home are usually covered. You may have to enroll in a plan that works with your nursing home pharmacy, but the facility should help you choose the right coverage.

If you live in a nursing home, you may be able to enroll in a Medicare Advantage Special Needs Plan, which has benefits designed to best serve residents of a long-term care facility. These plans include Part D prescription drug coverage and may be more affordable than other Medicare plans. You may also qualify for a Special Needs Plan if you are on both Medicare and Medicaid.

What About Respite Care

Sometimes your daily caregiver may need a rest. In this situation your hospice team may arrange for you to receive inpatient respite care in a Medicare-approved facility on an occasional basis. You can stay in the facility up to 5 days each time you get respite care.

Some Medicare Supplement plans cover the copayment or coinsurance for this respite care, when itâs approved by Medicare.

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Your Costs For Hospice Care Under Medicare

Medicare Part A covers most hospice services in full, but you may have the following out-of-pocket costs:

• A maximum of $5 per prescription for drugs used to control the symptoms and pain of your terminal illness

• Up to 5 percent of the cost of inpatient respite care

• Room and board if you live in a facility that is not for hospice care, such as a nursing home, but choose to receive hospice care there

Keep in mind

You are free to stop hospice care any time you want to and then resume it if thats your wish. Medicares hospice coverage continues as long as your doctor and a hospice doctor continue to certify that youre terminally ill, even if you live longer than six months.

You can use Medicare benefits to get care for health problems that arent a part of your terminal illness, paying for any of Medicares copayments and deductibles as usual. But once you choose hospice care, you cant use your Medicare benefits to cure your terminal illness.

Original Medicare will cover your hospice benefits, even if youve chosen a Medicare Advantage plan. If you already had a Medicare Advantage plan before you started hospice care, you can choose to stay in that plan if you pay the monthly premiums. The plan can cover care not related to your terminal illness.

Which Services Are Not Covered By Medicares Hospice Benefit

Medicare will not cover these items and services once your hospice benefit starts:5

• Treatment intended to cure your terminal illness and/or related conditions
• Prescription drugs that arent for your terminal illness or related conditions
• Care from any provider that wasnt set up by the hospice medical team
• Room and board*
• Care you get as a hospital outpatient , care you get as a hospital inpatient or ambulance transportation

*If your hospice team decides you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.6

Medicare may cover these services if your hospice team arranges it or its unrelated to your terminal illness and related conditions.7

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How Much Does Hospice Cost With Medicare

Hospice care is usually covered under Medicare Part A benefits. If you qualify for hospice benefits under Medicare, you will incur the following costs:

• Your monthly Medicare Part A and Medicare Part B premiums
• All hospice costs will be covered by Medicare, including medical and nursing services, medical equipment, and any therapy services. There are no deductibles for these services
• You will incur copayments of up to $5 for prescription drugs for pain and symptom management Curative drugs are not covered and will need to be paid for out of pocket or covered by Medicare Part D or Medicare advantage
• You will pay 5% of the Medicare-approved cost of inpatient respite care
• You will cover the costs of room and board if you are in a long-term care facility since these are not included in Medicare hospice benefits.

Does Medicare Advantage Cover Hospice

Medicare Advantage does not pay for hospice services because those services are covered in full by Original Medicare. If you start hospice while you’re on Medicare Advantage, you can keep your plan as long as you continue to pay your premium. But hospice care is covered by Original Medicare even while you’re enrolled in a Medicare Advantage plan.

If you choose to keep your Medicare Advantage plan, you can get services not related to your terminal illness from plan providers or other Medicare providers. But you may pay all or part of the cost for nonnetwork care, and your plan may require referrals or preauthorizations. Your plan will continue to cover extra services like dental and vision if you pay your premium and follow plan rules.

Since hospice covers most of your care, you may question whether to continue paying Medicare Advantage premiums while on hospice. But if you cancel your plan and then leave hospice care later, you’ll go back to Original Medicare. You must then wait for an open enrollment period to return to Medicare Advantage.

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Who Pays For Hospice Care At Home

The Medicare Hospice Benefit covers end-of-life services related to a patients terminal diagnosis in whatever setting the patient calls home, whether thats a traditional residence, an assisted living facility, or nursing home. Wherever hospice occurs, all services related to the terminal diagnosis are covered up to 100% by Medicare Part A.

If the patients symptoms cannot be managed by the routine level of hospice care, additional levels of service, such as 24/7 continuous care or inpatient hospice care, will also be financed through Medicare Part A at no additional expense to the patient or family.

Medicare Hospice Benefit Exclusions

Once a patient on Original Medicare is certified to be terminally ill and in need of hospice care, the Medicare hospice benefit takes effect. However, Medicare will not cover the following costs:

• Curative prescription drugs: Original Medicare will only cover the cost of drugs given for symptom relief or pain management, but it will not cover any curative drugs to cure your condition.
• Treatment procedures: Any services or treatments intended to cure your condition will not be covered under the Medicare hospice benefit since this benefit is only meant to cover comfort care without curative intent.
• Room and board: if you are receiving hospice care in a long-term care facility like a nursing home, Medicare does not cover the cost of room and board. If the hospice team determines that you need short-term inpatient or respite care services, Medicare will cover those costs.

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Medicare And Hospice Guidelines Faq

Does Medicare cover hospice in a nursing home or other long-term care facility?Yes, hospice services can be provided to eligible patients in their nursing homes or long-term care facility, as well as their personal home or a hospital.

Can a patient receive skilled nursing care and hospice care at the same time?Medicare regulations prohibit patients from receiving concurrent enrollment in hospice and skilled nursing care for the same diagnosis. In rare cases, a patient may receive skilled nursing care for a diagnosis unrelated to their terminal illness while receiving hospice services.

Understanding Hospice Care Under Medicare

Medicare defines hospice care as âa special way of caring for people who are terminally illâ . The goal of hospice care is generally to keep the patient comfortable rather than try to cure the ailment.

Your hospice care might involve a team of caregivers. For example, your team might include a physical therapist, occupational therapist, nutrition counselor, and others â depending on your needs.

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S Of Medicare And Hospice Coverage

Medicare is broken down into different parts: A, B, C, D, and Medigap. To qualify for the hospice-care benefit from Medicare, you need Medicare Part A, which covers hospital insurance and all other conditions. Medicare typically pays your hospice provider for your hospice care and theres no deductible, but youll pay the remaining cost of monthly Medicare Part A or Medicare Part B premiums.

Medicare Part A covers most medically necessary hospital, skilled nursing facility, home health, and hospice care treatments, and also provides caregivers with respite. Under Medicare Part A, youll need to meet specific conditions certified by a hospice doctor and regular doctor.

• Your hospice doctor and regular doctor must certify that you are terminally ill and expected to live six months or fewer.
• You agree to accept palliative or comfort care instead of curing your illness.
• You sign a statement accepting hospice care instead of other Medicare treatments for terminal illness.

Medicare Part B provides outpatient and medical coverage, which includes certain doctors services, outpatient care, medical supplies, x-rays, mental health care and some home health, and other preventative services.

Medicare Part C, also called Medicare Advantage, offers the same coverage of Original Medicare with, in many cases, additional benefits related to hearing, vision, and dental health. These plans are offered by private insurers.

What Hospice Care Isnt Covered By Medicare

Medicare wont cover hospice care provided by an agency that isnt Medicare certified. You must get hospice care from the Medicare-certified provider you choose, and all care must be included in your individualized plan of care and arranged by the hospice team. You cant get the same type of care from a different hospice unless you change your provider, which you can do once in each benefit period.

Once your hospice benefit starts, Medicare wont pay for:

• Treatment intended to cure your terminal illness or related conditions.For instance, if you want to pursue chemotherapy for your cancer treatment, hospice under Medicare wont generally cover it unless its considered palliative.
• Prescription drugs to cure your illness .
• Room and board. Medicare doesnt cover room and board if you get routine hospice care in a nursing home or a hospice inpatient facility. If your hospice team determines that you need general inpatient or respite care that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
• Around-the-clock care if you are receiving routine hospice care.
• Care you get in an emergency room or a hospital unless it is arranged by your hospice team or is not related to your terminal illness or related conditions. Medicare doesnt cover ambulance transport either unless your hospice arranges it. If you are enrolled in hospice and have urgent needs, call your hospice, not 911.

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What Hospice Care Does Medicare Part A Cover

Medicare defines a set of core services that all hospices are required to provide to each person they serve. Medicare Part A may cover these hospice services when theyâre needed during terminal illness and related condition and ordered by your hospice care team:

• Doctor services
• Medical equipment
• Medical supplies
• Prescription drugs for symptom control or pain relief
• Hospice aide and homemaker services
• Physical and occupational therapy
• Grief and loss counseling for you and your family
• Short-term inpatient care
• Short-term respite care
• Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team