How Much Hospice Costs And How To Pay For It

The following discussion is about Original Medicare. The coverage for Medicare Advantage policies depends on the terms of each policy. To learn more about Medicare  Advantage policies, see Private  Insurance, above.

What is necessary before Medicare covers hospice care

If you qualify for Medicare Part A, you will be covered for the costs of hospice if:

• The hospice organization has a Medicare approved hospice program. Approximately 80% of hospice organizations have the necessary certification.  
• You have certification from your doctor that you are terminally ill and probably have less than six months to live if your illness runs its normal course. A revision of the rules in 2000 made it easier for doctors to refer patients to hospice. Before the change, doctors had to be  fairly certain of a life expectancy of six months or less. The Wall Street Journal describes the current state of the time frame as " more of a loose estimate." 
• You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. 

Medicare provides care for two 90-day periods followed by an  unlimited number of 60-day periods.  At  the start of each period of care, in order for coverage to continue, your  doctor must re-certify that you are terminally ill. Even if you live longer  than six months, you can continue to get hospice  care as long as your doctor re-certifies that you are terminally ill.

Hospice services and supplies Medicare covers

Medicare covers nearly all of the costs associated with hospice care, including the following:

• Doctor services.
• Nursing care. 
• Medical equipment (such as wheel chairs and  walkers). 
• Medical supplies.  
• Medications for pain management and control of  symptoms such as nausea, vomiting, and diarrhea. 
• Short-term  hospital care, as needed for pain and symptom management. 
• Respite Care to give your family caregivers a break in their duties. You may stay in a Medicare approved hospital, private hospice facility, or nursing home, up to 5 days at a time.   
• Home health aide services. 
• Homemaker services. 
• Physical and occupational therapy. 
• Speech therapy. 
• Social worker services. 
• Nutritional counseling. 
• Mental health counseling for hospice patients  and their family. 
• Regular Medicare benefits are available to treat  medical conditions unrelated to the terminal illness. 
• Grief and loss counseling for you and your  family.

Medicare also pays for:

• Covered  benefits for any health problems that aren't related to your terminal illness. 
• A  one-time-only consultation with a hospice medical director or doctor to discuss  your care options and management of pain and symptoms. You don't have to choose  hospice care for this consultation to be covered.

You Pay:

• Prescription  Drugs:
  • The hospice is allowed to charge 5% of the reasonable cost up to $5.00 per prescription for outpatient drugs (those used in the home) for pain management and symptom control. The costs of these medications are covered in full when provided on an inpatient hospice basis.
  • Medicare Parts A and B do not pay for prescription drugs to cure your illness rather than for symptom control or pain relief. They may be covered separately if you are enrolled in a Medicare prescription drug coverage plan.    
• Respite Care: If you go into a hospital or other facility to give your  caregivers a break, currently you can only be charged a maximum of 5% of the total Medicare pays for respite care in that facility. (The amount can vary from year to year). The average out of pocket expense is about $5.00 a day, but can vary depending upon geographical location. 
• Room and board at home or in a nursing home or hospice residential facility except if the hospice medical team determines that you need short term in-patient or respite services. 
• Care in an emergency room, in-patient facility, or ambulance unless arranged by your hospice medical team. 
• Treatment to cure your terminal illness, though you can stop respite care and have such costs covered.

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