Hospice care

You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:

• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
• You accept comfort care (palliative care) instead of care to cure your illness.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

If you qualify, you can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You have the right to change your hospice provider once during each benefit period. How do I choose a hospice care provider?

You can usually get Medicare-approved hospice care in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might be responsible for the entire cost of your hospital care. What's a hospice care team?

Once you choose hospice care, your hospice benefit should cover everything you need. You and your family will work with your hospice care team to set up your plan of care.  What kinds of services does a plan of care include?

Your costs in Original Medicare

• You pay nothing for hospice care if you get your care from a Medicare-approved hospice provider. How do I know if a hospice provider is Medicare-approved?
• You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to find out if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
• You may pay 5% of the Medicare-approved amount for inpatient respite care (short-term care to help give caregivers a rest). Your copay can’t exceed the inpatient hospital deductible for the year.

• Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but you'll owe any deductible and coinsurance amounts that apply. Once you choose hospice care, your hospice benefit will usually cover everything you need.
• You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.
• If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might be responsible for the entire cost of your hospital care. 

Note: You can ask your hospice provider for a list of items, services, and drugs that they’ve determined aren’t related to your terminal illness and related conditions. This list must include why they made that determination. Your hospice provider must give you the list within 3-5 days of your request, depending on when you made it. Your provider must also give this list to your non-hospice providers or Medicare, if requested.

What it is

Hospice is end-of-life care for people with illnesses that cannot be cured.

Things to know

Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (after a face-to-face meeting with the hospice doctor or hospice nurse practitioner) that you’re still terminally ill. 

If you’re in a Medicare Advantage Plan or other Medicare health plan:

• Your plan must help you locate a Medicare-approved hospice provider in your area.
• Original Medicare will cover everything you need related to your terminal illness once your hospice benefit starts, even if you stay in your plan.
• You can stay in your plan as long as you continue paying your premiums. If you decide to leave hospice care, your plan will start again the first day of the following month.
• Your plan can still cover services that aren't part of your terminal illness and related conditions.
• You can get services unrelated to your terminal illness from either providers in your plan’s network or providers that participate in Original Medicare.
• What you pay will depend on the plan and if you follow the plan’s coverage rules (like using in-network providers). If your plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services as long as you continue to pay your plan’s premiums and other costs.

Medicare won't cover any of these once your hospice benefit starts:

• Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. Can I stop hospice care?
• Prescription drugs to cure your illness (rather than for symptom control or pain relief).
• Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
• Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility.
• Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Patient Choice

The IMPACT Act was focused on payment and resource use in the 4 PAC settings that are reimbursed via a prospective payment system (IRF, LTCH, SNF and Home Health), and the text of the final rule does not specifically include hospice. However,  in the preamble the final rule (excerpt below) , CMS communicates that - for all destinations - , discharge planning should be based on the basic principles outlined in the rule, including consideration of patient preferences:  

Discharge planning is an important component of a successful transition from hospitals and PAC settings. The transition may be to a patient's home (with or without PAC services), skilled nursing facility (SNF), nursing facility (NF), long term care hospital (LTCH), rehabilitation hospital or unit, assisted living center, substance abuse treatment program, hospice, or a variety of other settings. While Medicare regulations define ''post-acute care'' providers to include SNFs, LTCHs, inpatient rehabilitation facilities (IRFs) and home health agencies (HHAs), it should be noted that there are other services that can be provided by entities other than PAC providers (that is, LTCHs, IRFs, HHAs, and SNFs), including assisted living facilities, home and community-based services, or primary care providers. The location to which a patient may be discharged should be based on the patient's clinical care requirements, available support network, and patient and caregiver treatment preferences and goals of care.

Medicare Important Message

According to guidance issued by the Centers for Medicare & Medicaid Services (CMS) in May 2007 (Transmittal 1257CP), a follow-up copy of the Important Message from Medicare (IM) is not required for hospital inpatients who elect hospice care before discharge. This policy was established to align with the nature of hospice elections, which involves shifting from curative care to palliative care. 

Key details of the 2007 guidance

• Purpose of the IM: The IM, introduced in 2007, informs Medicare beneficiaries of their right to appeal a premature discharge from the hospital to a Quality Improvement Organization (QIO). The follow-up IM, delivered 1–2 days before discharge, reinforces these rights at the point they become most relevant.
• Hospice election exemption: When a beneficiary elects hospice while still in the hospital, the goal shifts from active, curative inpatient care to palliative care coordinated by the hospice provider. Because a QIO appeal is specifically for challenging a hospital's decision to end curative treatment, the standard discharge appeal process is no longer applicable.
• Rationale for the exclusion: The exclusion of hospice patients from receiving the follow-up IM prevents confusion for beneficiaries. Since they have elected hospice, their care plan is no longer a matter for the standard hospital discharge appeal process.
• Current relevance: While this specific guidance is from 2007, the principle remains in place. For hospice elections made in the hospital, the required notices shift from the standard discharge appeal forms (like the IM) to notices specific to the hospice benefit. This ensures the beneficiary is informed of their hospice-related rights rather than irrelevant discharge appeal rights.