Does Medicare or Medicaid Cover Hospice?

Does Medicare Cover Hospice?

Medicare-approved hospice programs may cover all costs directly related to pain relief and symptoms associated with a terminal illness. Medicare will cover certain costs for up to six months. However, after six months, patients can continue to receive Medicare-covered hospice care if the hospice doctor recertifies that the individual is still terminally ill. Coverage includes the following:

• Treatment from members of the patient’s hospice care team, including hospice doctors, nurse practitioners, and nurses.
• Physical, speech, and occupational therapy services.
• Hospice home health aides and homemaker services.
• All components and equipment needed for pain relief and symptom management (including prescriptions).
• Rental or purchase of durable medical equipment.
• Nutritional and dietary guidance.
• Grief and spiritual counseling for the patient and their family.
• Short-term inpatient or respite care services if deemed necessary by the patient’s hospice care team.
• Medical-related hospice care within a skilled nursing facility (excluding room and board costs).

Hospice Benefits Not Covered Under Medicare

It’s important to note what benefits Medicare does not cover once hospice care is initiated. These include the following:

• Lifesaving medical treatments to cure terminal illness.
• Room and board, including long-term residence in the patient’s home, a nursing home, or a hospice facility.
• Any prescription medication to cure or rehabilitate the terminal illness.
• Hospice care outside of the designated hospice provider. The patient’s appointed hospice care team must organize all treatments.
• Outpatient or inpatient hospital care and ambulance transportation. This rule doesn’t apply if the patient’s hospice care team has scheduled care or if the care is unrelated to the terminal illness.

Learn more about what isn’t covered by Medicare in the video below.

What Are the Medicare Requirements for Hospice Coverage?

To qualify for Medicare hospice coverage, the individual needs to meet the following requirements:2

• The individual must have Medicare Part A.
• A hospice doctor must diagnose and certify the patient as terminal (meaning they have six months or less to live) via a face-to-face appointment.
• The individual must sign a statement choosing palliative care (comfort care) instead of other lifesaving benefits.

How Much Does Medicare Pay for Hospice?

While Medicare fully covers a large portion of hospice services, including medical equipment, treatment from the hospice care team, and occupational, physical, and speech services, the patient may incur costs for some services:

• Up to a $5 copayment per prescription for outpatient drugs to relieve pain and manage terminal illness-related symptoms.
• Five percent of the Medicare-approved cost for inpatient respite care.

Does Medicaid Cover Hospice?

Medicaid is a partnership between the federal government and individual states. Medicaid-covered hospice care is optional and varies by state. States that do provide Medicaid-funded hospice benefits must follow federal regulations for basic coverage that are similar to Medicare and include:

• At least 210 days of hospice care.
• A hospice care team including doctors, nurses, and nurse practitioners.
• Home health aides and homemaker services.
• Rental or purchase of medical appliances and supplies.
• Physical therapy, occupational therapy, and speech-language pathology services.
• Prescriptions for pain relief and management.
• Grievance and counseling services for the hospice patient and their family members.
• Short-term inpatient or respite care services.

Medicaid is state-run, so it’s essential to confirm if your state offers Medicaid-covered hospice care and what benefits are included within the coverage.

What are the Medicaid Requirements for Hospice?

The requirements to qualify for Medicaid hospice care will vary from state to state. If the patient qualifies for Medicaid, however, they must follow the requirements for Medicaid’s hospice benefits.2 Common requirements include:

• A hospice plan of care must be established before services are provided.
• A hospice physician must certify that the individual is terminally ill.
• The individual must complete a hospice election statement.
• The individual must elect the hospice benefit by completing an election statement.
• A specific hospice provider must be selected and will serve as the individual’s care team.
• The individual must waive all Medicaid services to cure the terminal condition.

The time when someone can begin using Medicaid coverage for hospice services is based on the individual state’s determination of life expectancy. For example, Indiana defines a terminal illness as having a life expectancy of six months or less, while Colorado requires a prognosis of nine months or less.3

What is the Cost of Hospice Care for Patients on Medicaid?

Older adults who qualify for Medicaid-covered hospice care are exempt from copayments, coinsurance, and deductibles. Hospice care, including room and board, is covered under Medicaid whether the individual lives at home or resides in a nursing home, assisted living facility, or rehabilitation center.4 Because Medicare doesn’t offer hospice coverage for room and board, this is an excellent benefit.

How Else Can I Pay for Hospice?

If an individual doesn’t qualify for Medicare or Medicaid, or their coverage simply isn’t adequate, there may be other ways to pay for hospice care.

While hospice care isn’t cheap, Medicare and Medicaid can pay for a large percentage of the costs. Even if you or your loved one does not qualify, you have a few different options to pay for hospice care. Be sure to consult with your family and an elder care financial planner to find the best funding option for you.