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, Original Medicare will automatically pay for your hospice care. Your Medicare Advantage Plan will continue to pay for care that is unrelated to your terminal condition.
*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.