Does Medicare cover Hospice, Palliative & respite care

What about Medi Gap, Medicare Advantage & ACA/Obamacare?

Hospice Coverage
Introduction

Hospice is a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families. Here are some important facts about hospice:

■ Hospice helps people who are terminally ill live comfortably.
■ Hospice isn’t only for people with cancer.
■ The focus is on comfort (palliative care), not curing an illness.
■ A specially trained team of professionals and caregivers provide care for the “whole person,” including  physical, emotional, social, and spiritual needs.
■ Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal  illness and related conditions.
■ Care is generally given in the home.
■ Family caregivers can get support.

To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions. Publication 02154

Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include:

any or all of these services: 

When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren’t working.

Resources & Links

NPR  Home Hospice can be tough on families 1.21.2020

Medicare won’t cover any of these once your hospice benefit starts:

  • Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief).
  • Care from any hospice provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.  medicare.gov/hospice-care

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Your costs in Original Medicare

  • $0 for hospice care.
  • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D Rx
  • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

Medi Gap Plan G…

hospice coverage under medi gap

plan g coverage hospice

 

Medicare Advantage

See typical Evidence of Coverage page 69 

Official Medicare #Hospice Publication  # 02154  

you tube videos

Costs of the last 2 months of life 

costs of last 12 months of life

 

See our webpage on

Anthem Medicare Supplement

Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help

Related resources

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