You are here: Home Government ... Medicare: ... Original Fee-For Service ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Medicare: Original Fee-For-Service

Original Fee-For Service Medicare: Hospice Care

Next » « Previous


  • The goal of hospice care is to care for a terminally ill person in the final months of life, not to cure the illness.
  • Hospice care is usually provided at home with care from a Medicare certified hospice agency. In special circumstances, hospice may be provided on an inpatient basis.
  • Hospice Care Is Covered Under Medicare Part A. If you start on hospice care, you can return to regular medical care at any time. 
  • You always have the right to stop getting hospice care and go back to your regular doctor or health plan. That will not prevent you from rejoining the hospice program at a later date.  

What is hospice care?

When the treatment goals change from cure to care, a hospice can:

  • Manage the patient's pain and symptoms so that the patient can have as good quality of life as possible in the time remaining.
  • Deliver palliative care in the patient's home, or in a home-like setting, and supplement family caregiving.
  • Provide practical, emotional, and spiritual support to the patient and the family.

Generally, hospice care is provided in your home with a family member or close friend coordinating the care between the hospice team and volunteers.

Your doctor and a nurse from the hospice will evaluate your situation and work with you and your family to set up a plan of care that meets your needs. Benefits are approved for a 90-day period and may be renewed for another 90-day period. If more care is required, the physician may re-certify you for an unlimited number of 60-day periods.

The plan of care includes the hospice services you need that are covered by Medicare. The care is meant to help patients make the most of the last months of life by giving comfort and relief from pain. The focus is on care, not cure.

  • Volunteers are trained to help with everyday tasks, such as shopping and personal care services, like bathing and dressing.
  • A family member or other person who cares for you will be with you every day and members of the hospice team will make regular visits.
  • A nurse and a doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when needed.
  • If you should need care in a hospital for your illness, the hospice team will help arrange your stay.

Eligibility For Hospice Care Under Medicare

You are eligible for Medicare hospice benefits when all of the following occur:

  • You are eligible for Medicare Part A.
  • Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live. The certification is based on the doctor's clinical judgment regarding the normal course of your illness. The law understands that such certifications are not always exact. (Clinical information and other documentation supporting the medical prognosis must accompany the written certification).
  • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness. In essence, you consent to pain and symptom relief (palliative care) rather than curative care.
  • You receive care from a Medicare-approved hospice program.

What Does The Medicare Hospice Benefit Cover?

Medicare hospice benefit covers nearly 100% of the cost of:

  • Doctor services
  • Nursing care
  • Medical equipment such as wheelchairs and walkers
  • Medical supplies such as bandages and catheters
  • Drugs to control symptoms and pain relief
  • Sort-term care in the hospital, including respite care. (Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home.)
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social worker services
  • Dietary counseling
  • Bereavement counseling to help you and your family with grief and loss.

Even if you choose hospice care, Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.

The cost of hospice care is minimal to you. You will have to pay:

  • No more than $5.00 for each prescription drug and other similar products. The hospice can charge up to $5.00 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
  • 5% of the Medicare payment amount for inpatient respite care. For example, if Medicare pays $100 per day for inpatient respite care, you will pay $5.00 per day. You can stay in a Medicare-approved hospital or nursing home up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care.

What Doesn't The Medicare Hospice Benefit Cover?

  • Treatment to cure your terminal illness. As a hospice patient, you can get comfort care to help you cope with your illness, not cure it. Comfort care includes drugs for symptom control and pain relief, physical care, counseling and other hospice services. Hospice uses medicine, equipment, and supplies to make you a s comfortable and pain-free as possible. It is advisable to talk with your doctor if you are thinking about potential treatment to cure your illness. (As a hospice patient, you always have the right to stop getting hospice care and go back to your regular doctor or health plan.)
  • Care from another hospice that was not set up by your hospice.You must get your hospice care form the Medicare-approved hospice that you and your doctor chose to provide the services.
  • Care from another provider that is the same care that you must get from your hospice.  Once you are part of a hospice program, all of your care must come through the hospice setting and be authorized by the physician coordinating your care.  

How Long Does The Hospice Care Benefit Last?

  • Hospice care is authorized for two 90 day periods followed by an unlimited number of 60 day periods.
  • Once the first 180 days are up, a doctor or nurse practitioner must have a face-to-face meeting with the hospice patient to determine whether the patient continues to be eligible for hospice. The recertification must be passed on to Medicare.
  • The patient does not have to recertify a choice to use hospice care. 

What If The Hospice Care Benefit Is Terminated?

Congress created special appeal rights for beneficiaries who are at risk of discharge or termination of services from a hospice. A notice triggers your right to request an expedited determination -- you have the right to have an independent agency review the hospice program's discharge decision.

Hospice programs are permitted to discharge patients only in 3 situations:

  • You move from the hospice's service area or you transfer to another hospice 
  • The hospice determines that you are no longer terminally ill 
  • The hospice determines that your behavior is disruptive, abusive or uncooperative to the extent that delivery of care to you or the ability of the hospice to operate effectively is seriously impaired.. 

The hospice must advise you that a discharge for cause is being considered and make a serious effort to resolve the problem. 

For More Information About The Hospice Care Benefit:

Medicare has a booklet on Medicare Hospice Benefits (HCFA 02154). You may get a copy at: offsite link  or by calling 1.800.MEDICARE (800.633.4227). 

To Learn More

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.