Medicare and Hospice
What It Is
Hospice care for terminally ill patients, at home or in a hospice inpatient facility or hospital.
Medicare Part A covers hospice care, including nursing, personal care, medication, and respite care, provided by a Medicare-certified hospice. To qualify, a treating physician must certify that the patient has a terminal illness and probably has less than six months to live.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for hospice care, contact the plan directly.
What Medicare Pays
Medicare Part A pays the full Medicare-approved amount for hospice care. The patient is responsible only for up to five dollars for each prescription medication provided by hospice. For each day the patient is a hospice inpatient in a hospital or hospice facility, the patient must pay a co-payment of 5 percent of the Medicare-approved amount for that inpatient hospice care.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.