Medicare coverage of hospice care

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Medicare will help pay for your hospice care if you meet all of the following criteria:

  • You have Part A;
  • The hospice medical director (and your doctor, if you have one) certify that you have a terminal illness (your life expectancy is six months or less)*
  • You sign a statement electing to have Medicare pay for palliative care such as pain management, rather than care to try to cure your condition
  • Your terminal condition is documented in your medical record
  • You receive care from a Medicare-certified hospice agency

You do not need to be homebound to qualify for the Medicare hospice benefit. The benefit is a comprehensive set of services delivered by a team of providers. A lot of hospice services are provided in the home but inpatient care is covered under specific circumstances.

The hospice benefit is always covered under Original Medicare. If you have a Medicare Advantage plan and elect hospice, your hospice care will be paid for by Original Medicare.

*The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods. You must have a face-to-face meeting with a hospice doctor or nurse practitioner if you reach your third benefit period. The third benefit period begins on day 180 of hospice. After that, you must continue to have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each following 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm you still qualify for hospice care.


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LINKS
National Eldercare Locator

Resources for Aging: The Caregiver Sourcebook

Center to Advance Palliative Care

Hospice Patients Alliance: Consumer Advocates

National Hospice and Palliative Care Organization

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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