Hospice, Palliative & respite care
How does Medicare, Medi Gap, Medicare Advantage & ACA/Obamacare cover it?
Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include
any or all of these services:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Prescription drugs for symptom control or pain relief
- Hospice aide and homemaker services
- Physical therapy services
- Occupational therapy services
- Speech-language pathology services
- Social work services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short term respite care
- Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team
When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren’t working.
Medicare won’t cover any of these once your hospice benefit starts:
- Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
- Prescription drugs to cure your illness (rather than for symptom control or pain relief).
- Care from any hospice provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
- Room and board. Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
- Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.
Contact your hospice team before you get any of these services or you might have to pay the entire cost.
Your costs in Original Medicare
- $0 for hospice care.
- You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Part D Rx
- You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
- Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
You can get hospice care if you have Medicare Part A (Hospital Insurance) AND meet all of these conditions:
- Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (you’re expected to live 6 months or less).
- You accept palliative care (for comfort) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less.
- How hospice works
- Medicare Part A coverage—hospice
- Find hospice care
- National Hospice and Palliative Care Organization (NHPCO)
- Hospice Association of America (HAA)
- Hospice Foundation of American (HFA)
- Medicare & You: hospice (video)
- Publication # 02154 Hospice
- Los Angeles times opinion on hospice at home
- Steve Lopez: After my mother’s disastrous hospice experience, we filed a state complaint. It came to nothing
- UCLA grants wishes
- Under 65 ACA/Obamacare Evidence of Coverage see page 82
- A service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. (2014 ACA Sample EOC Page 166) CA WIC §14059.5
- Compare & Contrast Palliative & Hospice Care NIH.Gov
- Medicare Processing Manual – Hospice Claims 78 pages
- My Jewish Learning.com hospice & palliative care
- Jewish Law – Right to Die Jlaw.com
- Chabad Redondo Beach Facebook Live – you don’t need a Facebook account Jewish Perspective on End of Life Care
Hospice Publication # 02154
Costs of the last 2 months of life
click on graph to enlarge
Medicare and You 2020 #10050
Everything you want to know - Read Along