Medicare coverage of  Hospice, Palliative & respite care

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

Hospice Coverage

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: 

  • Doctor services
  • Nursing care
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Prescription drugs for symptom control or pain relief
  • Hospice aide and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care (for pain and symptom management)
  • Short term respite care
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team

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

Medi Gap Plan G…

hospice coverage under medi gap

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Medicare Advantage

See typical Evidence of Coverage page 69 

Official Medicare #Hospice Publication  # 02154  

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Costs of the last 2 months of life 

costs of last 12 months of life


See our webpage on

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).
    • If you pre planned  got Long Term Care or Home Health Care those may.

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:

  • Other insurance you may have
    • Medi Gap, Medicare Advantage?
  • How much your doctor charges

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.

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

Hospice, Euthanasia, Links & Resources

CA Dept of Aging – Home & Long Term Care ---

Revision  2018 pdf

Please note, there are updates all the time, double check everything.

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FAQ’s  Catheters

  • What catheters providers are in network with my plan
    • What plan do you have?Anthem Provider Finder


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      • Here’s the reply on 180 Medical about how Insurance covers catheters.180medical.comMedicare Coverage per 180 Medical 180medical.comWhat does your prescription say?

        Unlike Medicare, most Medicaid – Medi Cal? programs and most commercial insurers, UnitedHealthcare—the nation’s largest insurer—excludes urinary catheters from coverage for many commercial plans, lumping them in the same category as other excluded disposable supplies like elastic bandages and gauze. FAQ’s on Insurance Coverage

      • Anthem Medi Blue Plus HMO
        • OK, let’s check the Evidence of CoverageLet’s check for participating pharmacy’s Scroll down for the tool.CVS Pharmacy on Catheter’s

          You can use ANY participating pharmacy!

          • What about the 20% Co Pay?I wasn’t paying that with 180 Medical.
            • You’re right. Since you are not in CA, I can’t really help you. Try calling the agent who you purchased the coverage from or Blue Cross in your State.excerpt of CA Summary of Benefits
            • I’m not 100% sure if a Medicare Provider is allowed to waive the 20% charge. Here’s some links. It’s beyond my pay grade…


  • Catheter Fraud???  

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