Does Medicare Pay for Hospice Care at Home?
Understand Medicare's comprehensive coverage for hospice care at home. Learn about eligibility, included services, patient costs, and how to access support.
Medicare generally provides coverage for hospice care, including services delivered in a patient’s home. Hospice care offers a comprehensive program of support and comfort, focusing on pain relief and symptom management rather than curative treatments for individuals with a life-limiting illness. This type of care aims to enhance the quality of life during a challenging period. Hospice services can be provided in various settings, such as a patient’s home, a nursing home, or a dedicated hospice facility.
Medicare Hospice Benefit Eligibility
For an individual to qualify for Medicare’s hospice benefit, specific criteria must be met. A physician, along with the hospice medical director, must certify that the patient has a terminal illness with a medical prognosis of six months or less to live if the illness runs its normal course. This certification is a clinical assessment of eligibility.
The patient must choose to receive hospice care for their terminal illness, opting for comfort-focused palliative care instead of curative treatments. Patients retain the flexibility to discontinue hospice care at any time to pursue curative treatments, and they can re-elect the hospice benefit later if their condition warrants it. Individuals must also be enrolled in Medicare Part A, which is the hospital insurance component of Medicare.
Covered Services and Patient Costs
Medicare’s hospice benefit covers most services related to the terminal illness when provided at home. These include:
- Nursing care
- Physician services
- Necessary medical equipment (e.g., hospital beds, wheelchairs)
- Medical supplies (e.g., bandages, catheters)
- Prescription drugs for pain and symptom management
Additional covered services include:
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social work services
- Dietary counseling
- Grief and bereavement counseling for the patient and their family
These services are coordinated through an individualized care plan developed by the hospice interdisciplinary group.
Patients typically face very few out-of-pocket costs for Medicare-covered hospice care. There is often a small copayment, up to $5, for each prescription drug used for pain and symptom management. A 5% copayment may apply for short-term inpatient respite care, which offers temporary relief for the primary caregiver. For most other hospice services, there are no deductibles or copayments.
Services generally not covered include:
- Curative treatments for the terminal illness
- Prescription drugs not intended for symptom management
- Care from providers not arranged by the hospice team
- Room and board costs if care is received in a nursing home or assisted living facility
Accessing and Initiating Hospice Care
Beginning hospice care involves several steps, starting with identifying a Medicare-approved hospice agency. The Medicare website offers tools to locate and compare hospice providers, and recommendations from doctors or social workers can also be valuable.
Once a potential hospice agency is identified, the next step involves contacting them. The hospice agency will then collaborate with the patient’s attending physician to confirm eligibility based on medical criteria and to develop an initial care plan. When choosing a hospice, it is helpful to consider factors like the specific services offered, any accreditations, and patient or family reviews to ensure the agency can meet individual needs.
For enrollment, the patient or their legal representative must sign a statement acknowledging their choice of hospice care over other Medicare benefits for their terminal illness. This formal consent initiates the benefit period. Upon enrollment, the hospice team conducts an initial assessment, and services begin at the patient’s home, tailored to their specific needs.