Understanding Medicare Hospice Benefits

What is Hospice?

Hospice is a compassionate, patient-centered program focused on comfort and quality of life for terminally ill individuals. Rather than curative treatment, hospice care emphasizes palliative care—relieving pain and managing symptoms.

Eligibility for Medicare Hospice Benefits

To receive hospice care through Medicare Part A, a patient must:

• Get care from a Medicare-certified hospice.

• Be certified as terminally ill (prognosis of 6 months or less).

• Sign a statement choosing hospice care and waiving Medicare payment for treatment related to the terminal illness.

Benefit Periods

• Two 90-day periods, followed by an unlimited number of 60-day periods.

• Starting with the third period, a Face-to-Face (FTF) encounter with a hospice doctor or nurse practitioner is required for recertification.

Plan of Care (POC)

Care is guided by an individualized plan, developed by the hospice team, patient, caregiver, and attending physician (if any).

What Hospice Covers

Medicare’s hospice benefit includes:

• Physician and nurse practitioner services

• Nursing care

• Medical equipment and supplies

• Pain and symptom management medications

• Hospice aide and homemaker services

• Physical, occupational, and speech therapy

• Medical social work services

• Spiritual and dietary counseling

• Grief and bereavement support for the family

• Short-term inpatient care and respite care

• Other necessary services outlined in the care plan

Hospice Levels of Care

Medicare pays a daily rate based on the level of care:

1. Routine Home Care – Provided at home (or SNF/assisted living) during non-crisis periods.

2. Continuous Home Care – For short-term crisis care at home; involves intensive nursing support.

3. Inpatient Respite Care – Temporary inpatient care (up to 5 days) to relieve caregivers.

4. General Inpatient Care – For uncontrolled pain or symptoms requiring hospitalization.

Patient Costs (Coinsurance)

• Drugs & Biologicals: Up to 5% coinsurance per prescription (not more than $5), only for home care settings.

• Respite Care: 5% of the Medicare-approved amount, capped at the annual inpatient hospital deductible.

Helpful Resource

Visit the official website: Centers for Medicare & Medicaid Services https://www.cms.gov/ for more details tailored to Medicare hospice Coverage.