The underlying premise behind hospice care is to focus on the quality of life for patients who present with a life-limiting illness and are not expected to live more than six months, instead of seeking treatment to prolong the condition or to seek a medical cure. Hospice focuses on the entire person and supports the family by combining all elements of physical, emotional, and spiritual needs. Do you understand what the hospice benefits are and how they work?
Who’s Eligible for the Medicare Hospice Benefit?
According to the Centers for Medicare & Medicaid Services, if you have Medicare Part A (Hospital Insurance) AND meet all of the following conditions, you can receive hospice care:
- Your hospice doctor or your regular doctor (if you have one) certify that you’re terminally ill (meaning you’re expected to live six months or less).
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness. (If you choose hospice care, you have the right to change your mind and receive treatment for your illness.)
What Medicare Covers
Once the hospice benefit starts, original Medicare will cover everything needed relating to the terminal illness. However, the care must come from a Medicare-approved hospice provider.
Hospice care is generally provided in the home but can also be covered in a hospice inpatient facility. Depending on the terminal illness and the plan of care your hospice team creates, any or all of these services may be included:
- Skilled nursing
- Medical equipment
- Medical supplies
- Prescription drugs
- Social workers
- Home health aides
- Bereavement support
- Speech-language pathology services
- Physical and occupational therapy
- Dietary counselling
- Short-term inpatient and respite care
How Long Can You Receive Hospice Care?
Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than six months, you can still receive hospice care as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.
Hospice care is given in benefit periods. You can receive hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. A benefit period begins the day you sign up to receive hospice care and ends when your 90-day or 60-day benefit period ends. At the beginning of the first 90-day benefit period, your hospice doctor and your regular doctor (if you have one) must certify that you are terminally ill.
At the start of each benefit period after the first 90-day benefit period, the hospice medical director or other hospice doctor must recertify that you are terminally ill, so you can continue to receive hospice care.
For More Information
To learn more about Medicare eligibility, coverage, costs, and to obtain official Medicare publications and resources, visit Medicare.gov or contact 1-800-MEDICARE.
- Medicare Hospice Benefits [Internet]. 2023 Mar. Available from: https://www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF
- Wermuth HR, Tadi P. Hospice Benefits [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554501/