Also Known As:
Medicare Part A hospice coverage, Medicare Hospice Benefit, Medicare end-of-life coverage
Type:
Federal health insurance program for adults 65+ and certain disabled individuals
Primary Purpose:
To cover hospice care in full for eligible beneficiaries under Medicare Part A.
When It Applies:
When the patient is enrolled in Medicare Part A, meets hospice clinical eligibility (six-month prognosis), and elects the hospice benefit.
Who Is Involved:
The Centers for Medicare and Medicaid Services (CMS), the patient’s hospice provider, and the patient’s attending physician.
Where It Occurs:
Hospice care is delivered at the patient’s residence; Medicare pays the hospice agency a daily rate.
Duration:
For as long as the patient remains hospice-eligible. Eligibility is recertified at intervals throughout the stay.
Coverage:
100%, no co-pays, no deductibles for hospice services. A small copay (up to $5) for outpatient prescription drugs related to symptom management is allowed but rarely charged.
Key Focus:
Comprehensive hospice services including all four levels of care, full interdisciplinary team, medications, equipment, and bereavement support for at least 13 months.
Common Misunderstanding:
Electing the Medicare Hospice Benefit doesn’t end your other Medicare coverage. It replaces Medicare’s coverage of treatments aimed at curing the terminal illness, but unrelated conditions remain covered.
What Medicare Covers Under the Hospice Benefit
The Medicare Hospice Benefit covers everything in the hospice plan of care:
- Physician services and medical director oversight
- RN case management and 24/7 nursing on-call
- Hospice aide (CNA) personal care visits
- Social work, chaplaincy, and bereavement support
- All four levels of care (routine, continuous, GIP, respite)
- All medications related to the terminal diagnosis
- Durable medical equipment, bed, oxygen, wheelchair, commode
- Medical supplies, gloves, briefs, wound-care materials
- Volunteer services
- Bereavement support for at least 13 months after the death
What Medicare Doesn’t Cover Under Hospice
The hospice benefit replaces Medicare’s coverage of treatments aimed at curing the terminal illness. So while the patient is in hospice:
- Curative chemotherapy or radiation for the terminal cancer, not covered
- Diagnostic tests unrelated to comfort, not covered
- ER visits for the terminal condition, generally not covered, because hospice provides equivalent care at home
However, unrelated conditions remain fully covered. A broken arm, an unrelated infection, or a new condition that develops during hospice continues under standard Medicare.
How Hospice Is Paid
Medicare pays the hospice agency a per-diem rate for every day the patient is enrolled. The rate varies by level of care, higher for continuous care and general inpatient days, lower for routine home care. The family never receives a bill for hospice services.
If you have questions about Medicare hospice coverage, contact our team or call (972) 777-3000. A Lifted intake coordinator can verify Medicare eligibility in minutes.