Making decisions about hospice care, whether for yourself or someone you love, is not easy. Getting direct answers about what hospice costs and how you can pay for it may make a difficult decision a little clearer.
Original Medicare (Medicare Part A and Medicare Part B) does pay for hospice care as long as your hospice provider is Medicare-approved.
Medicare pays for hospice care whether or not you have a Medicare Advantage plan (an HMO or PPO) or another Medicare health plan.
If you want to find out whether your hospice provider is approved, you can ask your doctor, your state health department, a state hospice organization, or your plan administrator, if you have a Medicare supplemental plan.
You may be looking for specific answers about which facilities, providers, and services are covered in hospice care. This resource will help you answer those questions.
Medicare covers hospice as soon as a medical doctor certifies that someone covered by Medicare has an illness which, if it continues uninterrupted, makes it unlikely that the person will live longer than 6 months.
To get this coverage, you must sign a statement that confirms:
- you want palliative care
- you don’t intend to continue seeking treatments to cure the illness
- you choose hospice care instead of other Medicare-approved services to treat your illness
Original Medicare pays for a wide range of services, supplies, and prescriptions related to the illness that caused you to seek hospice care. That includes:
- doctor and nursing services
- physical, occupational, and speech therapy services
- medical equipment, like walkers and beds
- nutrition counseling
- medical supplies and equipment
- prescription medications you need to relieve symptoms or control pain
- short-term inpatient care to help you manage pain or symptoms
- social work services and grief counseling for both patient and family
- short term respite care (up to five days at a time) to allow your caregiver to rest, if you are being taken care of at home
- other services, supplies, and medications needed to handle pain or control symptoms related to the terminal illness
To find a hospice care provider in your area, try this agency finder from Medicare.
If you are receiving hospice benefits, Medicare Part A (original Medicare) will still pay for other illnesses and conditions you may have. The same co-insurance payments and deductibles will apply for those treatments as would ordinarily apply.
You can keep your Medicare Advantage plan while you’re receiving hospice benefits. You just have to pay the premiums for that coverage.
Only if life expectancy is less than 6 months. Dementia is a slow-progressing illness. In later stages, a person with dementia may lose the ability to function normally and require daily care. Hospice will only be covered, however, when a physician certifies that the person has a life expectancy of 6 months or less. That usually means that a secondary illness like pneumonia or sepsis has occurred.
The good news is that there are no deductibles for hospice care.
Some prescriptions and services may have copays. Prescriptions for pain medications or symptom relief may carry a $5 copay. There may be a 5 percent copay for inpatient respite care if you are admitted to an approved facility, so your caregivers can rest. Other than those instances, you won’t have to pay for your hospice care.
Medicare won’t cover any treatments to cure an illness
That includes both treatments and prescription medications that are intended to cure you. If you decide you want treatments to cure your illness, you can stop hospice care and pursue those treatments.
Medicare won’t cover services from a hospice provider that wasn’t arranged by your hospice care team
Any care you receive has to be provided by the hospice provider that you and your team chose. Even if you are receiving the same services, Medicare will not cover the cost if the provider isn’t the one you and your hospice team named. You can still visit your regular doctor or healthcare provider if you selected them to supervise your hospice care.
Medicare won’t cover room and board
If you are receiving hospice care at home, in a nursing home, or in an inpatient hospice facility, Medicare won’t cover the cost of room and board. Depending on the facility, that cost could exceed $5,000 per month.
If your hospice team decides that you need a short-term stay inpatient at a medical facility or in a respite care facility, Medicare will cover that short-term stay. You may owe a coinsurance payment for that short-term stay, however. In most cases, that payment is 5 percent of the cost, usually not more than $10 per day.
Medicare won’t cover care you receive in an outpatient hospital facility
It won’t pay for ambulance transportation to the hospital or for any services you receive in an outpatient hospital setting, such as the emergency room, unless it is not related to your terminal illness or unless it has been arranged by your hospice team.
If you (or a loved one) are receiving hospice care, that means your doctor has certified that your life expectancy is 6 months or less. But some people defy expectations. At the end of 6 months, Medicare will keep paying for hospice care if you need it. The hospice medical director or your doctor will need to meet with you in person, and then re-certify that life expectancy is still not longer than 6 months.
Medicare will pay for two 90-day benefit periods. After that, you can re-certify for an unlimited number of 60-day benefit periods. During any benefit period, if you want to change your hospice provider, you have the right to do so.
- Medicare Part A. Part A pays for hospital costs, should you need to be admitted to care for symptoms or to give caregivers a short break.
- Medicare Part B. Part B covers medical and nursing services, medical equipment, and other treatment services.
- Medicare Part C (Advantage). Any Medicare Advantage plans you have will remain in effect as long as you’re paying premiums, but you won’t need them for your hospice expenses. Original Medicare pays for those. Your Medicare Part C plans can still be used to pay for treatments that are not related to the terminal illness.
- Medicare supplement (Medigap). Any Medigap plans you have can help with costs related to conditions unrelated to the terminal illness. You won’t need these benefits to help you with hospice expense, since those are paid for by original Medicare.
- Medicare Part D. Your Medicare Part D prescription coverage will still be in effect to help you pay for medications that are unrelated to the terminal illness. Otherwise, medications to help treat symptoms or manage the pain of a terminal illness are covered through your Medicare hospice benefit.
Hospice is treatment, services, and care for people who have an illness and are not expected to live longer than 6 months.
Advantages of hospice care
Expertsencourage people with a terminal diagnosis to consider entering hospice earlier in the 6-month window. Hospice provides clear benefits and valuable supports, not just to patients but also to their families. Some of the benefits are:
- fewer exposures to infections and other hazards associated with hospital visits
- lower overall costs associated with the underlying illness
- resources to improve care and support caregivers
- access to expert palliative care services
The aim of palliative care is to improve your quality of life while you deal with an illness. Palliative care may begin the moment you are diagnosed with an illness, even if you’re expected to make a full recovery. You will most likely continue to receive palliative care until you don’t need it anymore.
According to the National Institute on Aging, the main difference between hospice and palliative care is that palliative care allows you to keep receiving treatments to cure your illness. In hospice care, your symptoms and pain will continue to be treated, but treatments aimed at curing the illness will stop.
If it becomes clear to the medical team that treatments are not working and your illness is terminal, you can transition from palliative care in one of two ways. If your doctor believes that you are not likely to live more than 6 months, you and your care providers may decide to transition to hospice care. Another option is to continue palliative care (including treatments intended to cure the illness) but with an increasing focus on comfort (or end-of-life) care.
How much hospice care costs depends on the type of illness and how early patients enter hospice. In 2018, the Society of Actuaries estimated that hospice patients with cancer received Medicare Part A and Part B benefits totaling around $44,030 during the last 6 months of their lives.
That figure includes the cost of inpatient hospital treatments, in addition to at-home hospice care. Another study showed that the average Medicare expense for hospice patients during the last 90 days of life was just $1,075.
Tips for helping a loved one enroll in Medicare
- Take a moment to be sure you understand how Medicare works.
- Familiarize yourself with enrollment timelines.
- Use this checklist to be sure you have the information you need to apply.
- Once you have gathered the information you need, complete the online application. You may want to minimize distractions and interruptions for at least 30 minutes.
If you have original Medicare coverage and you are considering hospice care, the Medicare hospice benefit will pay for the costs of hospice care.
You will need a doctor to certify that your life expectancy is not longer than 6 months, and you will need to sign a statement accepting hospice care and stopping treatments aimed at curing the illness. If you have met those requirements, your doctor and nursing care, prescriptions, and a whole range of other support services will be covered.
One important exception to note: Original Medicare does not pay for room and board for hospice patients, so long-term residence in a nursing home or skilled nursing facility won’t be covered as part of a hospice benefit.
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