Medicare-Provided Hospice Benefits

By Kendra Knouff
eMedicareSupplements Senior Writer

If you are part of a traditional Medicare plan and are considering enrolling in a hospice program, it is very important to know what is and is not covered by Medicare and what you are expected to pay.

Medicare will cover a one-time consultation with a hospice medical director or doctor in order to discuss possible care choices and methods for symptom and pain management, as well. You do not have to be enrolled in hospice before taking advantage of this benefit. Medicare will cover any hospice care that you receive due to a terminal illness, given that you have enrolled in a hospice care program that has been approved by Medicare.

Hospice services provided for your terminal illness that are covered by Medicare include:

• Doctor services
• Nursing care
• Medical equipment (such as wheelchairs or walkers)
• Medical supplies (such as bandages and catheters)
• Drugs for symptom control or pain relief (may need to pay a small co-payment)
• Hospice aide and homemaker services
• Physical and occupational therapy
• Speech-language pathology services
• Social worker services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care (for pain and symptom management)
• Short-term respite care (may need to pay a small copayment)
• Any other Medicare-covered services needed to manage your pain and other symptoms, as recommended by your hospice team

Medicare will also cover inpatient respite care needs that you may have. If your usual caregiver needs to take time off, you will be cared for in a Medicare-approved facility, such as a hospital or nursing home.

There are certain services that Medicare will not cover. These include:

• Treatment designed to cure your illness
• Prescription drugs to cure your illness rather than treat your symptoms
• Hospice care that was not set up and provided by your Medicare-approved hospice team. If you would like hospice services from a different provider, you must change providers and notify Medicare
• Room and Board: If you receive hospice services at home, in a nursing home or in a hospice facility, Medicare will not cover the cost of your room and board. If your hospice team decides that you need short-term inpatient or respite care services that they have arranged for you, Medicare will cover your stay. However, you may have a small co-payment.
• Care in an emergency room, inpatient facility care or ambulance transportation. These services are not covered unless they are arranged by your hospice team or are not related to the terminal illness for which you receive hospice care. Be sure to contact your hospice team before using these services, or you may have to pay their full cost.

Because Medicare covers the cost of hospice by paying the provider, there are only a couple of small costs you will be responsible for. You will have to pay no more than $5 for each prescription drug and other products for symptom and pain relief. You will also be responsible for 5 percent of the Medicare-approved amount for inpatient respite care. This means that if the approved amount is $100, you must pay only $5 per day. You can stay in a Medicare-approved facility for 5 days at a time.