Does Medicare cover hospice? What's covered and what isn't

What does Medicare cover?

Hospice covers the services in your loved one's plan of care, which the hospice team sets up with you. Depending on their needs, that can include:

• Doctor services and nursing care
• Medical equipment, like wheelchairs or walkers
• Medical supplies, like bandages and catheters
• Prescription drugs for pain and symptom control
• Hospice aide and homemaker services
• Physical, occupational, and speech therapy
• Social worker services and dietary counseling
• Grief and loss counseling for your person and your family
• Short-term inpatient care for pain and symptoms
• Short-term respite care, so a caregiver can rest

The care must come from a Medicare-approved hospice.

What will you pay?

There is no deductible. Medicare says you pay nothing for hospice care from a Medicare-approved provider. You may pay:

• A copay of up to $5 per prescription for outpatient drugs for pain and symptoms
• 5% of the Medicare-approved amount for inpatient respite care
• Room and board, if your person lives in a facility like a nursing home

Your person still pays their usual Part A and Part B premiums.

What isn't covered?

Once hospice starts, Medicare won't cover:

• Treatment or drugs meant to cure the terminal illness
• Care from a provider the hospice team didn't set up (your person can still see their regular doctor if they chose that doctor as their attending)
• Room and board at home or in a facility, except short inpatient or respite stays the hospice arranges
• Emergency room visits, hospital stays, or ambulance rides, unless the hospice team arranges them or they are unrelated to the terminal illness

Call the hospice team before getting any of these services. If you don't, you might have to pay the full cost.

What about other health problems?

Original Medicare still covers health problems that aren't part of the terminal illness and related conditions. Your person pays the usual deductibles and coinsurance for that care. You can ask the hospice for a written list of items, services, and drugs it has decided are not related, with the reasons.

What about Medicare Advantage, Medicaid, or private insurance?

Once hospice starts, Original Medicare covers everything related to the terminal illness, even if your person stays in a Medicare Advantage Plan. If they keep paying the plan's premiums, the plan can still cover extras like dental and vision, and care for unrelated problems.

Hospice is an optional Medicaid benefit, so coverage depends on your state. Private insurance plans vary. Call the plan and ask what it covers.