How Much Does Medicare Pay Hospice Per Day?

The Medicare Hospice Benefit provides comfort and support for individuals facing a terminal illness, along with their families. It focuses on palliative care, managing pain and symptoms rather than curing the illness. It is an elective choice, allowing individuals to receive specialized care focused on quality of life during their final months.

Medicare Hospice Eligibility

A physician must certify that the patient is terminally ill, with a prognosis of six months or less to live if the illness runs its normal course. This certification requires clinical judgment from both the patient’s attending physician and a hospice physician.

The patient must also be enrolled in Medicare Part A, which covers hospital insurance, and elect to receive hospice care. By electing hospice, the patient chooses palliative care for their terminal illness and related conditions, waiving Medicare payments for curative treatments for those specific conditions. Hospice care is initially provided for two 90-day benefit periods, followed by an unlimited number of 60-day periods, as long as the patient is recertified as terminally ill.

Covered Services and Patient Costs

Medicare’s hospice benefit covers many services provided by an interdisciplinary team. These services typically include nursing care, physician services, medical social services, and spiritual counseling. Patients also receive necessary medications for pain and symptom management, along with medical equipment and supplies.

Additional covered services encompass physical and occupational therapy, speech-language pathology services, and home health aide and homemaker services. The benefit also provides short-term inpatient care for pain control or acute symptom management that cannot be managed at home, and respite care to offer temporary relief for primary caregivers. Grief and bereavement counseling is also available for the family.

Medicare covers 100% of the costs for hospice care services. Patients incur minimal out-of-pocket expenses. There may be a copayment of up to $5 for each outpatient prescription drug. For inpatient respite care, a coinsurance of 5% of the Medicare-approved amount may apply, though this amount cannot exceed the inpatient hospital deductible for that year. Room and board costs are not covered if the patient resides in a nursing home or assisted living facility, unless they are receiving short-term inpatient or respite care.

Understanding Daily Payment Rates

Medicare compensates hospice providers through a daily payment rate to cover all services in a patient’s individualized care plan. This daily rate is paid to the hospice provider and not directly to the patient. The specific daily payment amount varies based on the level of care required by the patient.

There are four levels of hospice care recognized by Medicare. Routine Home Care (RHC) is the most common level, for patients receiving services at home with stable symptoms. Continuous Home Care (CHC) is provided during periods of crisis, requiring a higher level of care, predominantly nursing, for at least eight hours in a 24-hour period to manage acute symptoms at home.

Inpatient Respite Care (IRC) offers short-term inpatient care, typically for up to five consecutive days, to provide temporary relief for the primary caregiver. This care is provided in an approved inpatient facility, such as a hospice inpatient unit or skilled nursing facility. General Inpatient Care (GIP) is for pain control or acute symptom management that cannot be managed in other settings, requiring a short-term stay in a hospital or inpatient hospice facility.

Medicare updates these payment rates annually, adjusted based on the geographic location’s wage index, reflecting local labor costs. For Fiscal Year 2024, hospice payments saw a 3.1% increase for providers that meet quality reporting requirements. The daily rates cover all necessary services, ensuring providers can deliver comprehensive end-of-life care.