Also Known As:
MHB, Medicare hospice coverage, Part A hospice benefit
Type:
Federally administered hospice insurance benefit
Primary Purpose:
To pay for all hospice-related care, including all four levels of care, the full team, medications, and equipment, at no cost to eligible Medicare beneficiaries.
When It Applies:
From the day of hospice election forward, for as long as the patient continues to meet eligibility.
Who Is Involved:
CMS, the hospice agency, the patient’s attending physician, and the hospice medical director.
Where It Occurs:
Pays for care delivered at home, in assisted living, in nursing facilities, and in hospice inpatient units.
Duration:
Two 90-day benefit periods followed by unlimited 60-day periods, as long as eligibility continues.
Coverage:
100%, no deductibles, no co-pays for hospice services.
Key Focus:
Comprehensive, four-level, team-based hospice care without financial barrier.
Common Misunderstanding:
The benefit isn’t time-limited. As long as the patient continues to show decline and meet eligibility, the benefit continues, even past six months, even past a year.
How the Benefit Is Structured
The Medicare Hospice Benefit was created in 1982 to cover comprehensive end-of-life care for Medicare beneficiaries. It is one of the most generous benefits in the U.S. healthcare system, and one of the most underutilized.
Eligibility is structured around benefit periods:
- First 90-day benefit period
- Second 90-day benefit period
- Unlimited 60-day benefit periods after that, with face-to-face recertification before each one
At each transition, the hospice physician and attending physician confirm that the patient still meets the six-month prognosis criteria. See face-to-face visits.
What the Benefit Includes
Every service in the hospice plan of care is covered, every nurse visit, every aide visit, every social work session, every chaplain visit, every medication related to the terminal diagnosis, every piece of equipment, and the entire bereavement period.
The family does not see itemized bills for hospice services. There is no co-insurance, no deductible, and no claim process for the family to manage.
Why So Many Texas Families Underuse It
Despite being fully covered, the Medicare Hospice Benefit is dramatically underused. Studies have consistently shown that most patients enroll within the last weeks of life, when the full benefit of the benefit can no longer be realized.
The most common reasons are misunderstanding, assuming hospice is only for the last few days, assuming it means giving up, assuming it costs money. None of those assumptions are accurate. Read our plain-language guide to what hospice care actually is.