How Long Will Medicare Pay for Hospice?

Hospice care offers a specialized approach for individuals facing a terminal illness, shifting the focus from curative treatments to comfort and quality of life. This care provides comprehensive support for patients and their families, addressing physical, emotional, and spiritual needs. Medicare, the federal health insurance program, includes a benefit designed to cover these services, ensuring eligible individuals can access the care they need.

Eligibility for Medicare Hospice Benefits

To qualify for Medicare hospice benefits, an individual must meet specific criteria. A physician and the hospice medical director must certify that the individual has a terminal illness with a prognosis of six months or less to live if the illness runs its normal course. This medical judgment is required for initiating hospice coverage.

The patient must also choose palliative care, focusing on comfort and symptom management, rather than pursuing curative treatments. This decision is formalized by signing an election statement, indicating the choice to receive hospice care from a Medicare-approved hospice provider. The individual must also be enrolled in Medicare Part A, the hospital insurance component. These steps ensure the individual is medically eligible and has formally chosen the hospice pathway.

Understanding Medicare Hospice Benefit Periods

Medicare’s hospice benefit is structured into distinct periods. Initially, a patient can receive care for two 90-day benefit periods. Following these, an unlimited number of 60-day benefit periods are available. Medicare can pay for hospice care for an extended duration, beyond the initial six-month prognosis.

For each subsequent benefit period after the first 90 days, a hospice physician or nurse practitioner must re-certify that the individual is still terminally ill with a life expectancy of six months or less. This re-certification involves a face-to-face encounter with the patient before the third benefit period and all subsequent 60-day periods. The “six months or less” prognosis is a medical determination; coverage can continue indefinitely with proper re-certification if a patient lives longer.

These benefit periods are sequential, restarting with each new certification. The hospice provider must obtain verbal or written certification within two calendar days after the start of each benefit period. This process ensures Medicare continues to cover hospice services as long as eligibility criteria are met.

Services Covered and Patient Financial Responsibility

Medicare hospice benefits encompass services to provide comfort and support.

Covered Services

Physician services
Skilled nursing care
Medical equipment (e.g., wheelchairs, hospital beds)
Medical supplies (e.g., bandages)
Drugs for pain and symptom management (small copayment may apply)
Home health aide and homemaker services
Physical and occupational therapy
Speech-language pathology services
Social worker services
Dietary counseling
Grief and loss counseling for the patient and family
Short-term inpatient care for pain or symptom management
Short-term respite care (temporary relief for caregivers)

Financial Responsibility

Medicare covers 100% of approved hospice costs. A copayment of up to $5 may apply for outpatient prescription drugs for pain and symptom management. For inpatient respite care, a 5% coinsurance of the Medicare-approved amount may apply, not exceeding the inpatient hospital deductible for the year. Medicare does not cover room and board costs if hospice care is received in a patient’s home, nursing home, or other facility, unless it is part of short-term inpatient or respite care.

Changing Your Medicare Hospice Election

Individuals can manage their Medicare hospice election as needs change. A patient can stop hospice care at any time by revoking the benefit. To do this, the individual or their representative must provide a signed written statement to the hospice, specifying the effective date of the revocation. Verbal revocation is not accepted.

Upon revoking hospice benefits, Medicare coverage reverts to standard benefits, allowing curative treatments. The remaining days in the current hospice election period are forfeited. If an individual later decides to resume hospice care, they can re-elect the benefit, provided they still meet eligibility criteria, such as the terminal illness prognosis. Re-electing hospice does not impact the total duration of available benefits; new benefit periods begin with each re-election, subject to continued medical eligibility. Individuals can also change their hospice provider once during each benefit period.