How does Medicare Hospice work?

Even if you are enrolled in a Medicare Advantage plan, hospice care is always covered under Original Medicare and will follow Original Medicare’s cost and coverage rules. To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. Coverage includes the following:

  • All items and services needed for pain relief and symptom management
  • Medical, nursing, and social services
  • Drugs for pain management
  • Durable medical equipment for pain relief and symptom management
  • Aide and homemaker services
  • Other covered services you need to manage your pain and other symptoms, as well as spiritual and grief counseling for you and your family.

Medicare-certified hospice care is usually given in your home or other facilities where you live, like a nursing home.

You will pay nothing for hospice care but may have 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. If you receive inpatient respite care, you may need to pay 5% of the Medicare-approved amount. Room and board are also not covered when you get hospice care in your home or another facility where you live.

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