Medicare Hospice Benefit: Compassionate Care at End of Life

Medicare's hospice benefit is one of the most comprehensive and compassionate benefits in the program -- yet it is widely misunderstood and underused. Many families wait too long to elect hospice, missing weeks or months of comfort and support that could have significantly improved quality of life. Here is how the Medicare hospice benefit works.

Hospice is a philosophy of care focused on comfort, dignity, and quality of life -- rather than curative treatment -- for people with a terminal illness. Hospice does not hasten death; it provides expert symptom management, emotional support, and practical assistance that allows people to live as fully as possible in their final months.

Hospice care is provided wherever the patient calls home -- a private residence, assisted living facility, or nursing home.

To elect Medicare hospice, you must:

1. Be enrolled in Medicare Part A
2. Have a terminal illness -- a doctor must certify that you have a life expectancy of 6 months or less if the illness runs its normal course
3. Choose comfort care over curative treatment -- you elect to receive palliative care rather than treatment aimed at curing the terminal illness

Important: Electing hospice does not mean giving up all medical care. You continue to receive Medicare coverage for conditions unrelated to your terminal illness. And if your condition improves or you change your mind, you can revoke the hospice election at any time.

The Medicare hospice benefit covers virtually everything related to the terminal illness:

Medical care:

• Physician services (hospice medical director and your attending physician)
• Skilled nursing visits
• Aide services (personal care, bathing, grooming)
• Social worker services
• Chaplain and spiritual care

Medications:

• All medications related to the terminal diagnosis -- covered at 100% (small copay for outpatient drugs, up to $5)
• Pain management medications
• Symptom control medications

Equipment and supplies:

• Hospital bed, wheelchair, bedside commode
• Oxygen
• Wound care supplies
• All medical equipment related to the terminal illness

Emotional and spiritual support:

• Counseling for patient and family
• Chaplain services
• Bereavement counseling for family (up to 13 months after death)

Respite care:

• Short-term inpatient care (up to 5 consecutive days) to give family caregivers a break

Medicare hospice is organized into benefit periods:

• Two 90-day periods
• Followed by unlimited 60-day periods

At the start of each period, a hospice physician must recertify that the patient still has a life expectancy of 6 months or less. There is no limit on the total number of benefit periods -- you can receive hospice care for longer than 6 months if you continue to qualify.

Medicare hospice is nearly free:

• No deductible for hospice services
• No coinsurance for most services
• Small copay for outpatient prescription drugs (up to $5 per prescription)
• 5% coinsurance for inpatient respite care

Many families delay hospice because they feel it means "giving up." Research consistently shows that hospice patients often live longer than similar patients who continue aggressive treatment -- and with significantly better quality of life. Having an honest conversation with your doctor about hospice when the time is appropriate is one of the most important things you can do for yourself or a loved one.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.