If you or a loved one are eligible for hospice, Medicare will provide coverage for as long as desired. Your medical team must certify that hospice is necessary to receive ongoing care.
Hospice can only be initiated if a person has an end stage illness. This usually means a person’s life expectancy is less than 6 months.
As such, Medicare coverage for hospice includes two initial 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
Your primary healthcare professional and your hospice care coordinator must certify that you have an end stage illness to initiate the first 90-day benefit period.
After the second 90-day benefit period ends, they must recertify your health condition at the start of each additional benefit period to continue receiving care.
You have the right to discontinue hospice at any time. You can restart hospice care at a later date if you’re still eligible and wish to do so.
Once you begin receiving hospice care, Original Medicare (Parts A and B) will cover all services related to your end stage illness, even if you’re enrolled in a Medicare Advantage (Part C) or other Medicare health plan.
Medicare will only cover hospice with a Medicare-approved provider or facility. Although hospice care is usually provided in a residence, you may be eligible for inpatient care at a hospital.
You don’t have to pay a deductible for hospice care. Medicare will pay your hospice provider directly, so you do not have to submit claims for reimbursement.
You’re still responsible for your Part A and B premiums, copayments, and coinsurance costs.
If you have Original Medicare and don’t meet the criteria for premium-free Part A, you’ll pay $278 or $505 each month. Most people will pay a monthly premium of $174.70 for Part B.
If you have Medicare Advantage, your monthly premium will depend on your chosen plan.
In either case, you can expect to pay:
- $0 for covered services
- $5 copayment for prescription drugs and similar products for pain relief or symptom management
- 5% of all Medicare-approved costs for inpatient respite care
Supplemental Medicare insurance (Medigap) can help cover any out-of-pocket costs associated with hospice, respite, or other care covered by Original Medicare.
Once you begin hospice, your hospice benefit should cover everything you need. You’ll work with your primary healthcare professional and your hospice coordinator to set up your care plan.
If you have questions about your coverage, you can call Medicare at 1-800-633-4227 (TTY: 1-877-486-2048) 24 hours a day, 7 days a week.
You can also contact your local State Health Insurance Assistance Program (SHIP) for personalized Medicare counseling. To find a program near you, call the SHIP National Technical Assistance Center at 1-877-839-2675.