Ensuring Comfort at the End: A Comprehensive Guide to Medicare’s Hospice Care Benefits

Nobody loves talking about end-of-life care. But the topic is critically important not just for patients themselves, but for patients’ loved ones and family members as well.

The comforting news is that nearly all costs for hospice services are covered under Medicare Part A. That means you have access to Hospice care whether you are enrolled in Original Medicare by itself, Original Medicare plus a Medigap policy, or a Medicare Advantage policy.

As long as you use one of the more than 5,000 Medicare-approved hospice care providers, Medicare will pick up all or nearly all of the cost.

Last year, these programs provided hospice services to nearly 2 million Medicare patients nationwid. 

What is Hospice Care?

Hospice services are designed to support patients who are terminally ill, by providing pain relief, increasing comfort, and reducing stress. 

At this point, the focus of care is no longer on curing or fighting the disease, but on managing symptoms, and making the patients’ remaining days as bearable and comfortable as possible.

Medicare-approved hospice programs can provide care in your home, a nursing home, or in a hospital setting. Generally, hospice care is provided wherever the patient feels most comfortable and calls “home.”

Who Qualifies for Hospice Care under Medicare?  

To receive free hospice care under Medicare, you must meet two criteria:

1.) You must be qualified for Medicare Part A.

2.) You must have a doctor’s certification that you have a remaining life expectancy of six months or less.

What does the Medicare hospice benefit provide?

Medicare’s hospice benefit covers all medical and support services for a terminal illness. These include:

• Pain relief drugs
• Drugs for symptom management
• Medical, nursing, and social services costs
• Certain durable medical equipment
• Hospice aides
• Homemaking assistance
• Spiritual and grief counseling for the patient and family members

24-hour care at home isn’t typically provided under the Medicare Hospice benefit. However, if you are experiencing a crisis, Medicare does cover continuous home care services, which includes nurse and home health aide services provided for between 8 and 24 hours per day to manage acute medical symptoms.

What does hospice care cost? 

 Hospice care has no deductible or copays, other than for respite care and drugs.

For drugs required for pain relief or symptom management, a nominal $5 copay applies.  

Respite Care

Caring for a loved one at the end of life can be physically and emotionally draining. Respite care allows the family or other people caring for the terminally ill patient at home to take a short break from caregiving. 

Respite care provides the caregiver temporary relief while ensuring that the patient continues to receive care.

Under the Medicare hospice benefit, respite care can be provided in a Medicare-approved facility such as a hospice inpatient facility, hospital, or nursing home. With respite care, the patient can be admitted for up to five days each time it’s needed. It can be provided on an occasional basis and can be planned or unplanned.

Respite Care Costs

During the respite care period, Medicare pays the hospice for the cost of the patient’s stay in the facility. 

Currently the copayment for out-of-home respite care is 5% of the Medicare-approved daily amount for inpatient respite care. 

For example, if the Medicare-approved amount is $200 per day, the copayment would be $10 per day. However, the specific amount can vary and should be checked annually for updates.

Respite care is not intended to be a regular part of the patient’s care plan, but rather an occasional service to give relief to the caregiver. 

Medicare’s standard cost-sharing applies to medically necessary palliative care if a patient is still getting treatment for their medical condition. Original Medicare, Medicare Advantage, and Medicare Part D deductibles, coinsurance, and copays.

Once the patient transitions to hospice care and is no longer getting treatment in an attempt to cure their original condition, the normal copays and deductibles no longer apply. 

How do I find a Medicare-approved hospice program? 

Medicare beneficiaries can utilize an online tool to find and compare hospice programs, which must be Medicare-approved. 

How long do Medicare hospice benefits last?

As long as needed.

In 2020, the median length of hospice care was 21 days. However, once you are approved for hospice care, you won’t lose that approval as long as you need that care.

When your doctor certifies you have less than six months to live, you will receive an initial approval of hospice care for up to 90 days. At the end of that period, your doctor must recertify that your life expectancy is less than six months.

You won’t lose coverage unless your doctor says you no longer have a life expectancy of six months or less, or if you refuse hospice care. 

Hospice and Medigap

Medigap, also known as Medicare Supplement Insurance, helps cover some of the healthcare costs that Original Medicare (Part A and Part B) doesn’t cover, like copayments, coinsurance, and deductibles.

When it comes to hospice care, Original Medicare covers most of the hospice services but requires a small copayment for outpatient prescription drugs and inpatient respite care.

In terms of outpatient prescription drugs, the copayment is usually no more than $5 for each medication provided for pain and symptom management. For inpatient respite care, the patient may need to pay 5% of the Medicare-approved amount.

Here is where Medigap can help. Depending on the specific Medigap policy, it may cover these copayments, providing full coverage for hospice care.

For example, Medigap Plans A, B, C, D, F, G, M, and N pay 50% or 100% of your Part A hospice care coinsurance or copayment. Medigap Plans K and L pay 100% of your Part A hospice care coinsurance or copayment once you reach the out-of-pocket yearly limit.

You should check the details of your specific Medigap policy to see how it covers these hospice-related costs. It’s also important to note that Medigap policies generally do not cover any services not covered by Original Medicare.

Please note that as of 2021, Medigap plans sold to new people with Medicare aren’t allowed to cover the Part B deductible, and Plan F and Plan C aren’t available to people new to Medicare. If you already have either of these two plans (or both) you can keep it. If you were eligible for Medicare before January 1, 2020, you may still be able to buy Plan F or Plan C.

If you have questions about your own specific situation, contact your Personal Benefits Manager. Their contact information is at the bottom of this email.

Hospice and Medicare Advantage 

In most cases, people don’t receive hospice benefits through their managed care organization under Medicare Advantage. Instead, Original Medicare will usually cover your hospice benefits directly.

If a Medicare Advantage enrollee in hospice care (provided under Original Medicare) needs treatment for something other than the terminal illness or related conditions, they can use Original Medicare or their Medicare Advantage coverage, if it’s still in force. 

Note: If a hospice patient needs prescription drugs for medications other than for their terminal condition, those drugs aren’t covered under the Medicare hospice benefit. Instead, they are covered normally under their Medicare Part D plan or Medicare Advantage plan.

This means they may have a deductible and copay for these drugs that is much larger than the $5 copay for palliative care drugs under the Medicare hospice benefit. 

This is often confusing for patients and their families. So expect to pay more out of pocket for any drugs other than those used for pain relief and symptom management for the terminal condition.

Thank you for subscribing. From all of us here at Medigap Advisors, we wish you the very best.

Here’s to your health and wealth,

Wiley P. Long, III
President – MediGap Advisors

Comfort at Life’s End: A Medicare Hospice Guide