Hospice care is a type of health care that focuses on the palliation of a terminally ill patient’s pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person’s goals.
You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:
- Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need. The following are four levels of hospice care:
ROUTINE HOME CARE
- Most common level of care in hospice. Patient is generally stable and the patient’s symptoms, like pain or nausea and vomiting, are adequately controlled
- Usually provided in the home
GENERAL IN-PATIENT CARE
• Crisis-like level of care for short-term management of out-of-control patient pain and/or symptoms usually provided outside the home, in an inpatient setting at a medical facility like a hospital or skilled nursing facility.
CONTINUOUS HOME CARE
- Crisis-like level of care for short-term management of out-of-control patient pain and/or symptoms
- Usually provided in the home.
- A level of temporary care provided in nursing home, hospice inpatient facility, or hospital so that a family member or friend who’s the patient’s caregiver can take some time off
- This level of care is tied to caregiver needs, not patient symptoms
Level of care is one of many things to consider when choosing a hospice. Patient and caregiver needs may impact the level of care a hospice provides. Additionally, hospices that see a small number of patients might not have patients that need a level of care besides routine home care. If you’re considering a hospice that hasn’t provided a level of care beyond routine home care in a 3-year period, talk to your doctor and/or hospice representative.
Your Costs in Original Medicare
- You pay nothing for hospice care.
- You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
- You may pay 5% of the Medicare-Approved Amount for inpatient respite care.
- You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.