If you have cancer and choose to get hospice care, Medicare will cover a range of services and supports.
What does Medicare cover with hospice care?
Medicare’s hospice benefits cover:
- Doctor visits
- Nurses to care for you
- Medical equipment and supplies
- Drugs to make symptoms or pain better
- Hospice aides and homemakers
- Physical, speech, and occupational therapy to help you move, talk and do daily activities
- Social workers
- Advice on what to eat
- Grief and loss counseling for you and your family
- Short-term, inpatient care if you need to go to the hospital to treat a problem not related to your illness, or to improve your comfort. For example, your doctors may want someone to watch you closely if they change your drugs.
- Short-term respite care to give your caregivers a break
- Any other Medicare-covered services needed to manage your pain and other symptoms. Your hospice team must recommend these.
What will Medicare NOT cover?
Under hospice, Medicare will not cover the following:
- Treatment to cure your terminal illness.
- Prescription drugs to cure your illness. Medicare will cover drugs to make your symptoms or pain better.
- Care from another hospice provider that your hospice medical team did not name. But, you can change your hospice provider if you like.
- Room and board in a skilled nursing facility. Medicare will cover short-term inpatient or respite services, but only when your hospice team arranges them. You may pay a small copayment for respite care.
What does hospice cost?
Medicare pays the hospice for most of your care. There is generally no deductible or coinsurance for hospice care. You only will have to pay your hospice provider:
- $5 or less for each drug. This includes prescription drugs and other products to help pain and symptoms
- 5% of the cost of inpatient respite care that Medicare approves. For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5 per day.
Who can get hospice benefits?
You can get Medicare hospice benefits if:
- You are eligible for Medicare Hospital Insurance (Part A), and
- Your doctor and the hospice medical director both certify that you are
- Terminally ill, and
- Expected to die within six months, and
- You choose hospice care and waive your right to other Medicare-covered benefits to treat your terminal illness, and
- You get care from a hospice program that Medicare approves.
Talk with your medical team before you start to get any of these services. Make sure Medicare approves your hospice, or you may have to pay the entire cost of these services.
What happens if I continue living beyond 6 months?
You can still get hospice care as long as you are terminally ill. The hospice medical director or other hospice doctor must certify that you are terminally ill.
You can get hospice care for two periods of 90 days each. After that, you can get an unlimited number of 60-day periods. At the start of each period of care, the hospice medical director or other hospice doctor must recertify that you are terminally ill.
Can I stop hospice care if it is not right for me?
Yes. You have the right to stop getting hospice care for any reason. You can also stop hospice care if your health improves or your illness goes into remission. Once you stop your hospice care, you go back to the same type of Medicare coverage you had before you chose a hospice. And, if you are eligible, you can go back to hospice care at any time.