Medicare covers hospice care under Medicare Part A, but to qualify, a patient must meet the following eligibility requirements:
Doctor Certification
- A hospice doctor and the patient’s primary physician (if they have one) must certify that the patient has a terminal illness with a life expectancy of six months or less, assuming the disease follows its normal course.
Choosing Comfort Care Over Curative Treatment
- The patient must choose hospice care instead of treatments aimed at curing their illness (e.g., chemotherapy, radiation for cancer treatment, or dialysis for kidney failure).
- However, hospice care can include treatments that help manage symptoms (e.g., pain relief, breathing treatments).
Receiving Care from a Medicare-Approved Hospice Provider
- The patient must receive services from a hospice provider that is Medicare-certified to qualify for coverage.
Regular Eligibility Reviews
- The patient is initially certified for two 90-day hospice periods (about six months total).
- If the patient is still alive after six months, a hospice doctor must recertify their eligibility for unlimited additional 60-day periods.
- If the patient improves and is no longer terminal, they can stop hospice care and resume regular Medicare benefits.
What Does Medicare Cover Under Hospice?
- Medical care for symptom management
- Medications & medical equipment (e.g., pain relief, wheelchairs, oxygen)
- Nursing care and home health aides
- Social services, counseling, and spiritual support
- Short-term inpatient or respite care (for caregiver relief)
- Bereavement support for the family
What Medicare Does Not Cover Under Hospice?
- Treatments intended to cure the illness
- Medications unrelated to the terminal diagnosis
- Room & board at a hospice facility, unless for short-term inpatient care
- Emergency care unless it’s unrelated to the terminal illness