Types of care that Medicare covers if I have a life-threatening illness and elect the hospice benefit
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Last Update: March 07, 2011
Hospice care is palliative care. This is care to make you physically and emotionally comfortable by managing your pain and symptoms.
Most hospice care is provided in your home, but inpatient care in a hospice, hospital and nursing facility care can also be covered. The amount and types of care you receive depend on your condition.
If you are eligible for hospice care, Medicare will pay for:
- Nursing services. Medicare pays in full for skilled nursing care services, which are performed by or under the supervision of a licensed nurse. Administration of medications, tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing.
- Skilled therapy services. Medicare pays in full for physical, speech and occupational therapy to manage your symptoms or to help maintain your ability to function or carry out activities of daily living (e.g., eating, dressing, toileting).
- Home health aide services. Medicare pays in full for a home health aide to provide personal care services including help bathing, using the toilet or dressing and some homemaker services.
- Durable medical equipment and medical supplies. Medicare pays in full for durable medical equipment and medical supplies needed to relieve pain or manage your medical condition.
- Short-term in-patient care to give relief to your caregivers. Medicare pays for inpatient hospital or nursing facility care to provide relief to your caregivers. This is called respite care. You will pay a copay of no more than 5 percent of the Medicare approved amount for each respite day. Your total copays for respite care should be no more than the inpatient hospital deductible amount for the year you first elected hospice care. The hospital deductible is $1,184 in 2013.
- Short term inpatient care to manage symptoms and control pain. Medicare will cover short-term in-patient care in a hospice, hospital or nursing facility if your pain and symptoms cannot be managed in any other place. This includes when your caregiver cannot or will not provide you the care you need at home.
- Medical social services. Medicare pays in full for services from a social worker (under the direction of a doctor) that help you and your caregivers with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
- Prescription drugs. The Medicare hospice benefit only covers prescription drugs related to pain relief and symptom control. Inpatient prescription drugs are covered in full. Your cost can be no more than $5 for each outpatient prescription filled. To get Medicare-coverage of other prescription drugs unrelated to pain relief and symptom control of your condition, you have to be enrolled in a Medicare private drug plan.
To learn more about the Medicare drug benefit, click on the link in the GO TO box.
- Spiritual or religious counseling care. Medicare pays in full for spiritual or religious counseling.
- Nutrition and dietary counseling. Medicare pays in full for dietary counseling.
To find your MAC, call 1-800-MEDICARE or click on the link in the LINKS box.
If you have questions about billing for hospice care you should contact your Medicare Administrative Contractor (MAC). MACs are regional, you should call 800-MEDICARE to find out how to contact your local MAC.