Hospice and the Medicare hospice benefit: what is covered and what you pay

Who qualifies

Medicare Part A covers hospice when a hospice doctor and the person's regular doctor certify a life expectancy of six months or less if the illness runs its course, and the person chooses comfort-focused care instead of treatment meant to cure, by signing an election statement. Coverage runs in two 90-day periods followed by unlimited 60-day periods, each needing recertification. A person can stop hospice and go back to regular Medicare, and start again later.

What is covered

Once elected, Medicare's page says the hospice benefit should cover everything the person needs for the terminal illness, arranged by the hospice team under a plan of care you help set: nursing and doctor visits, drugs for pain and symptom control, short-term inpatient care the hospice arranges, and short-term respite care so the caregiver can rest. Care comes to wherever the person lives, and the person can keep their regular doctor as the attending physician.

What you pay

• Nothing for covered hospice services from a Medicare-approved hospice.
• Up to $5 for each prescription for pain and symptom management.
• 5 percent of the Medicare-approved amount for inpatient respite care, capped at the inpatient hospital deductible.

What is not covered

Treatment meant to cure the terminal illness, drugs for that purpose, care from providers the hospice did not arrange, and emergency or hospital care not arranged by the hospice. Medicare's page asks families to check with the hospice team before getting any of these, to avoid a bill. The biggest gap: room and board. If the person lives in a nursing home or assisted living, Medicare pays the hospice but not the rent. That part stays private pay, long-term care insurance, or Medicaid.

In a facility

Hospice can come into assisted living and nursing homes; the hospice handles the illness and the building handles daily living. Ask both sides who does what, who to call at night, and whether the facility's rate changes. On Medicaid in a nursing home, Medicaid typically continues paying the room and board while Medicare pays the hospice.

Questions for the hospice

• Are you Medicare-certified, and can we see your Care Compare rating?
• How often will the nurse and aide visit, and who answers at 2 a.m.?
• What equipment and medications will you provide, and how fast?
• How does respite work, and where?
• If we are in assisted living, what does the community keep charging, and what do you cover?