How Much Does Medicare Pay for Hospice Per Day?

Medicare provides a hospice benefit designed to offer comfort and support to individuals facing a terminal illness. This benefit shifts the focus from curative treatments to palliative care, aiming to manage pain and symptoms while enhancing the quality of life for the patient and their family. Under specific conditions, Medicare covers most costs associated with hospice care.

How Medicare Pays Hospice Providers

Medicare compensates hospice providers through a daily payment system, rather than paying the patient directly. This payment structure is a bundled rate, meaning it covers all services related to the terminal illness and its associated conditions. The Centers for Medicare & Medicaid Services (CMS) establishes these daily rates, which are subject to annual adjustments.

The amount Medicare pays per day varies based on the level of care provided. There are four distinct levels of hospice care recognized by Medicare:
Routine Home Care (RHC): Provided when the patient is at home and not experiencing an acute crisis.
Continuous Home Care (CHC): Offered during periods of crisis, requiring a higher intensity of nursing care predominantly in the patient’s home to manage acute symptoms.
Inpatient Respite Care (IRC): Provides temporary care in an approved facility for up to five consecutive days, offering relief to the primary caregiver.
General Inpatient Care (GIP): For short-term stays in an inpatient facility when symptoms cannot be managed effectively in other settings.

Medicare’s payment rates are highest for continuous home care and general inpatient care, reflecting the intensity of services required, while routine home care and inpatient respite care have lower daily rates.

Qualifying for Medicare Hospice Benefits

To receive Medicare hospice benefits, an individual must meet several specific eligibility criteria.
The patient must be entitled to Medicare Part A, which is the hospital insurance component of Medicare.
A physician and the hospice medical director must certify that the individual has a terminal illness with a medical prognosis of six months or less to live. This certification is based on clinical judgment and supporting documentation.
The individual must choose to receive hospice care instead of curative treatment for their terminal illness.
The patient or their authorized representative must sign an election statement, formally choosing the hospice benefit and waiving rights to Medicare payments for curative treatments related to the terminal illness.

Services Included in Medicare Hospice Care

The Medicare hospice benefit covers a comprehensive array of services for terminally ill patients and their families. These services are provided by an interdisciplinary hospice team and are designed to manage symptoms and provide comfort related to the terminal illness. All covered services are outlined in an individualized written plan of care.

Covered services include:
Physician services, nursing care, and medical social services.
Medications for pain management and symptom control.
Durable medical equipment (e.g., wheelchairs, hospital beds) and medical supplies (e.g., bandages, catheters).
Aide and homemaker services.
Physical therapy, occupational therapy, and speech-language pathology services.
Dietary counseling.
Grief and loss counseling for both the patient and their family, extending support before and after the patient’s death.
Short-term inpatient care for pain and symptom management.
Respite care to relieve caregivers.

Patient Costs Under Medicare Hospice

Patients receiving care under the Medicare hospice benefit generally face minimal out-of-pocket expenses. Medicare typically covers 100% of the approved costs for hospice care. There is no deductible for hospice services.

For prescription drugs used for pain and symptom management, a small copayment of $5 or less per prescription may apply. A 5% coinsurance of the Medicare-approved amount is required for inpatient respite care.

While hospice care covers all services related to the terminal illness, patients remain responsible for costs associated with health conditions not related to their terminal illness. If a patient chooses to pursue curative treatments for their terminal illness concurrently with hospice, those curative treatments would not be covered under the hospice benefit. However, Medicare will continue to cover services for unrelated health issues.

Initiating Medicare Hospice Services

Beginning Medicare hospice services involves a straightforward process. A patient or family member can initiate the process by contacting a Medicare-approved hospice provider directly. Many hospices offer initial consultations at no cost to help families understand the available services and eligibility.

Following initial contact, the hospice team conducts an assessment to determine the patient’s needs and confirm eligibility. If the patient meets the criteria, they will sign an election statement, formally choosing to receive hospice care.

The patient’s attending physician, if they have one, and the hospice medical director must certify the terminal illness, confirming the six-month or less prognosis. Once the hospice benefit is elected, the chosen hospice provider becomes responsible for coordinating and providing all care related to the terminal illness. Patients retain the right to revoke the hospice benefit at any time and return to standard Medicare coverage if they choose to pursue curative treatments or for any other reason.