How Long Will Medicare Pay for Inpatient Hospice Care?

Hospice care offers comfort and support for individuals facing a terminal illness, focusing on quality of life rather than curative treatments. This specialized care extends to their families, providing comprehensive support during a challenging time. Medicare plays a significant role in financing hospice services for eligible beneficiaries.

Eligibility for Medicare Hospice Benefits

To qualify for Medicare hospice coverage, an individual must meet specific criteria. A physician, along with a hospice physician, must certify that the patient has a terminal illness with a prognosis of six months or less to live if the illness follows its natural course.

Along with the medical prognosis, the individual must choose to receive comfort care, also known as palliative care, for their terminal illness instead of pursuing curative treatments. The care must be provided by a hospice program that is certified by Medicare.

Understanding Medicare Hospice Benefit Periods

Medicare’s coverage for hospice care is structured into distinct benefit periods. Initially, beneficiaries are entitled to two 90-day benefit periods. Following these, an unlimited number of 60-day periods can be accessed.

For each benefit period after the initial two 90-day periods, a hospice physician or nurse practitioner must re-certify that the patient remains terminally ill with a life expectancy of six months or less. This re-certification process often includes a face-to-face encounter with the patient to confirm continued eligibility. There is no absolute time limit on how long Medicare will cover hospice benefits, provided the patient consistently meets these re-certification criteria. If a patient decides to revoke their hospice election, they can re-elect hospice care at a later time, provided they still meet the eligibility requirements.

What Medicare Covers in Inpatient Hospice Care

When hospice care is provided in an inpatient setting, such as a hospice inpatient unit, hospital, or skilled nursing facility, Medicare covers a comprehensive range of services, including nursing care, physician services, medical social services, spiritual, and dietary counseling.

Medicare also covers necessary medications for pain and symptom management, medical equipment, and supplies. Short-term inpatient care, known as General Inpatient Care, is covered for pain or acute symptom management that cannot be effectively managed in other settings. Additionally, short-term inpatient respite care is covered for up to five consecutive days to provide relief for family caregivers.

Patient Financial Responsibility

Medicare generally covers 100% of the approved costs for hospice care once a patient meets the eligibility criteria. However, there are a few specific instances where a patient might have a minor financial responsibility. A small copayment, generally not exceeding $5, may apply for prescription drugs used for symptom control and pain relief.

Another exception is a 5% coinsurance for inpatient respite care, which provides temporary relief for caregivers. This coinsurance for respite care is distinct from general inpatient care, which typically has no patient cost. Medicare does not cover room and board costs if the inpatient facility is primarily serving as the patient’s residence rather than providing short-term general inpatient care or respite care.