As a program to care for people who are terminally ill, hospice presents a very difficult situation for loved ones and caregivers. Worrying about how to get hospice covered with Medicare and how you will pay is the last thing on everyone’s mind! Luckily, hospice is covered with Medicare is the same for all beneficiaries regardless of the plan they are enrolled; Medicare Supplement or Medicare Advantage. Learn more about what hospice covers, what it doesn’t cover, the costs for care, and how your current Medicare plan may or may not be needed.
What is Hospice?
Hospice is for patients diagnosed with a terminal illness and given a life expectancy of six months or less. The focus of hospice care is a shift from curative treatments to comfort care for the patient. The goal is to address the patient’s needs and not the illness.
Services under hospice include medical care, pain management, and spiritual and emotional support for quality of life. It also provides support for family caregivers during this difficult time. Hospice care is typically administered in the patient’s home, but can also be provided in hospice facilities, hospitals, or nursing homes.
What does Medicare cover for Hospice care?
Medicare provides hospice benefits for beneficiaries on Original Medicare. The care must be from a Medicare approved Hospice provider and must be related to the terminal illness. Medicare covers everything needed for palliative care of the terminal illness and related conditions.
Covered hospice services may include:
- One-time hospice consultation prior to deciding on Hospice
- Doctor and Nurse services
- Medicare equipment and Supplies
- Prescription drugs
- Hospice aide and homemaker services
- Physical, occupational, and speech-language pathology service
- Social worker and grief and loss counseling for patient and families
- Dietary Counseling
- Short-term inpatient care
- Short-term respite care
The Costs for Hospice Under Medicare
Once admitted to hospice care, Medicare will pay most of the above listed services without a deductible. You do need to continue your monthly Part A and Part B premiums. Most people qualify for Premium-free Part A, but if you did not have enough work credits then you will need to continue to pay your Part A premium to continue to receive hospice coverage.
The hospice services that require a copay are:
- Prescription drugs given to manage pain and symptoms have a copay of $5 per prescription. Part D does not cover the drugs administered through hospice care. This means you do not follow the copay schedule of your drug plan for prescriptions related to your illness.
- If you need inpatient respite care, you will pay 5% of the Medicare-approved amount when you receive care in a Medicare-approved facility.
Services Medicare will not pay under hospice
As mentioned, hospice coverage includes only palliative care to provide comfort and manage a patient’s pain from a terminal illness. It will not cover care for any condition that is not related to your terminal illness. This means you can receive care for other conditions, but the hospice benefit won’t cover it. You would revert to using whichever Medicare plan you have for their Medicare coverage.
For example, if you break your arm due to something unrelated to your terminal illness, hospice will not cover the treatment. You would need to seek care through your regular Medicare plan. Your costs are based on your plan or Original Medicare, depending on which one you have.
How your hospice benefits work with a Medicare Advantage or Medicare Supplement plan
When admitted to hospice, the benefits and costs highlighted above are covered and paid by Original Medicare, not your plan. However, you do still have a right to stay in your plan if you have a Medicare Advantage or a Medicare Supplement. Your plan can still cover any health care needs that are not part of your terminal illness. Essentially, you would use your hospice benefit for anything related to your illness, and then your plan for anything outside of that.
The care received outside of hospice benefits would be subject to your plan’s cost sharing. If you have a Medicare Advantage plan, this means using your network providers and paying the plan deductible, copays, or coinsurance. The Medicare Advantage plan is not billed for any hospice services.
If you have a supplement, then the supplement may pay your portion of the limited hospice charges for drugs and respite care. If you need care outside of hospice, then you would use your Original Medicare and Medicare Supplement plan to pay for services. You would be subject to any deductibles or costs outlined in your Medicare supplement.
Your hospice drugs are not billed under your Part D prescription drug plan. But if you need any prescriptions that are not related to your terminal illness, then your Part D plan will kick in to cover them.
If you only have Original Medicare when entering hospice, then Original Medicare would cover care for conditions not associated with your terminal illness. The costs would be subject to normal Part A and Part B deductibles and coinsurance.
Example Medicare Advantage Plan Member
Jane, a 68-year-old with a Medicare Advantage HMO plan, is diagnosed with terminal cancer. Upon electing hospice care, her hospice services are covered by Original Medicare. Jane decides to keep her Medicare Advantage Plan because it is a $0 premium. She comes down with a urinary tract infection unrelated to her condition while in hospice. She needs to use her Medicare Advantage plan to obtain care for the infection.
Should I end my Medicare Advantage or Medicare Supplement when admitted to Hospice?
The decision to keep or end your current Medicare plan depends on your scenario. You need to maintain your Part A and Part B, but you have the option to keep your other coverage. Always consult the healthcare professional in charge of your or your loved one’s condition before making any decisions. It is not uncommon for someone to improve and leave hospice. In this scenario, you may want to maintain the extra coverage.
If you are on a Medicare Advantage plan and it has a $0 dollar premium, then it is worth staying enrolled because it doesn’t cost anything extra to keep it. However, a Medicare Supplement generally does have a premium that can be costly. It will depend on your specific circumstances whether you would want to cancel your supplement or not. The costs of a supplement may not always make sense for someone who will never leave hospice. This is a discussion you would need to have with your care team. If you do drop your Medicare Supplement, you will still have Original Medicare for coverage. You may also be able to join a Medicare Advantage plan if it is during an enrollment period or if you have a special enrollment period. Make sure you speak with a licensed agent about available enrollment periods.
If you anticipate needing prescriptions unrelated to your condition, then it is a good idea to keep your Part D coverage.
Conclusion on Hospice Coverage
Medicare provides comprehensive hospice coverage. The coverage is the same whether you are enrolled in Original Medicare, a Medicare Supplement, or a Medicare Advantage plan. While hospice only covers care related to the terminal illness, you may still use your existing Medicare plan for unrelated medical needs. Deciding whether to keep your Medicare Advantage or your Medicare Supplement plan depends on your circumstances. Consulting with healthcare professionals and a licensed agent can help determine the best coverage strategy.
