Does Medicare Pay for Home Hospice Care?

Medicare provides health insurance coverage for millions of Americans. Understanding how Medicare supports end-of-life care is important for individuals facing serious illnesses. This article clarifies Medicare’s coverage for home hospice care, outlining eligibility, services, and access steps.

Medicare Hospice Eligibility

To qualify for Medicare hospice benefits, an individual must meet specific medical and administrative conditions. A primary requirement is a certification by both the hospice physician and the patient’s attending physician, if one exists, that the individual is terminally ill. This certification indicates a medical prognosis of six months or less to live if the illness runs its normal course.

Individuals must also be enrolled in Medicare Part A, which covers hospital insurance. A significant decision involved in electing hospice care is choosing comfort care, also known as palliative care, over curative treatments for the terminal illness and its related conditions. This means the focus shifts from attempting to cure the illness to managing pain and symptoms to enhance the patient’s quality of life. The patient, or their authorized representative, must sign a statement acknowledging this choice and electing hospice care.

Covered Home Hospice Services

Medicare’s hospice benefit covers a comprehensive range of services designed to provide comfort and support in the patient’s home setting. Nursing care is a core component, delivered by or under the supervision of licensed nurses, including services like injections, catheter changes, wound care, and ongoing assessment of the patient’s condition. Medical social services are also covered, offering support for social and emotional concerns related to the illness and helping to connect patients and families with community resources.

Physician services, whether from a hospice-employed doctor, nurse practitioner, or the patient’s chosen physician, are included in the benefit. The hospice team also provides counseling services, encompassing spiritual, dietary, and bereavement counseling for both the patient and their family. Short-term inpatient care for pain and symptom management is covered if symptoms cannot be managed at home, as is temporary respite care for up to five consecutive days to provide relief for caregivers.

Home health aide and homemaker services are integral, assisting with personal care tasks such as bathing, dressing, and light household duties. Physical, occupational, and speech-language pathology services are covered to help manage symptoms or maintain functional abilities for daily living. Additionally, necessary medical equipment, such as wheelchairs and oxygen, and medical supplies like wound dressings and catheters, are fully covered. Prescription drugs for pain relief and symptom control are also included, though a small copayment may apply for outpatient drugs.

Services Not Covered by Medicare Hospice

While Medicare’s hospice benefit is comprehensive, it does not cover all healthcare services or expenses. Treatment aimed at curing the terminal illness or its related conditions is not covered once hospice care is elected. Prescription drugs that are intended to cure the illness rather than manage pain or symptoms are also excluded from coverage.

Care provided by any healthcare professional or facility that is not arranged or approved by the hospice team is generally not covered. Medicare’s hospice benefit typically does not cover room and board costs if the patient resides in a nursing home, assisted living facility, or their own home. Exceptions are made for short-term inpatient care for symptom management or respite care, where the facility stay is covered. Lastly, emergency room visits or ambulance transportation are not covered unless they are arranged by the hospice team or are for conditions completely unrelated to the terminal illness.

Accessing Medicare Hospice Benefits

Initiating Medicare hospice benefits involves several procedural steps. The first step requires selecting a Medicare-approved hospice provider. Following the selection, both the patient’s attending physician and the hospice medical director must certify that the patient meets the terminal illness criteria, with a prognosis of six months or less to live.

After certification, the patient or their authorized representative signs an election statement. This document formally enrolls the individual in the Medicare hospice benefit and signifies their understanding of choosing palliative care over curative treatment for their terminal illness. The hospice benefit periods typically begin with two 90-day periods, followed by an unlimited number of 60-day periods.

For each subsequent benefit period, a re-certification is required to confirm that the patient continues to meet the eligibility criteria. Starting with the third benefit period, a face-to-face encounter between the patient and a hospice physician or nurse practitioner is mandated before re-certification. The hospice team then coordinates all covered services, developing an individualized plan of care.