Medicare Hospice Coverage: Eligibility & Guidelines

How Medicare Covers Hospice Care

Medicare is a federal health insurance program for senior citizens age 65 or older and certain younger individuals with qualifying disabilities. Hospice care is covered under Medicare Part A, which includes hospital care, skilled nursing, and end-of-life services for eligible patients.

Does Medicare cover hospice?

Yes, Medicare Part A covers hospice care for terminally ill patients who meet specific criteria and choose comfort care over curative treatment. Established in 1983, the Medicare hospice benefit provides quality end-of-life care without financial hardship.

Medicare hospice criteria: How to qualify for hospice under Medicare.

To qualify for hospice care under Medicare, you must meet the following eligibility requirements:

• You must be enrolled in Medicare Part A.
• A doctor must certify that you have a terminal illness with a life expectancy of six months or less if the illness runs its normal course.
• You desire to pursue comfort care instead of treatment aimed at curing the illness.
• You must receive care from a Medicare-approved hospice provider.
• You (or your representative) must sign a statement electing the Medicare hospice benefit.

Patients can continue receiving hospice care beyond six months as long as they remain eligible and are recertified at the end of each benefit period.

Medicare hospice benefit periods and recertification guidelines.

Medicare divides hospice care into benefit periods to ensure patients continue to meet eligibility requirements:

• Two initial 90-day benefit periods.
• Unlimited 60-day benefit periods thereafter.

After each benefit period, the patient must be recertified by a physician or hospice medical director to ensure they continue to meet Medicare’s criteria for hospice care.

What hospice services does Medicare cover? 

Once qualified for hospice care, Medicare covers a wide range of services, including:

• Care team services: Skilled nurses, aides, social workers, chaplains, and bereavement counselors provide care tailored to the patient’s physical, emotional, and spiritual needs.
• Medical equipment: Coverage includes essential equipment like a hospital beds, wheelchairs, or walkers.
• Medical supplies: Includes bandages, catheters, and incontinence products.
• Medications: Non-curative prescriptions for pain and symptom relief associated with their terminal illness.
• Bereavement Support: Grief counseling for families after a loved one’s passing.
• Short-term inpatient care: If symptoms require the resources of an inpatient facility, the Medicare hospice benefit provides coverage until the symptoms are controlled and the patient returns to their primary residence.
• Short-term respite care: Up to 5 days of inpatient care to give caregivers time to rest.
• Therapies: Physical, occupational, and speech therapies to improve quality of life.

Medicare also covers non-hospice-related healthcare costs through your existing Medicare plan.

What does the Medicare hospice coverage not include? 

While Medicare provides comprehensive hospice benefits, some services are not covered:

• Curative treatments: Medicare stops covering treatments aimed at curing the terminal illness once hospice is chosen.
• Unapproved providers: Care must be coordinated through your chosen Medicare-approved hospice organization.
• Room and board: Medicare does not cover room and board in long-term-care facilities unless the stay is for respite or short-term symptoms management.
• Unrelated services: Care unrelated to the terminal illness must be billed separately.

Patients and families should review their care plans to understand covered services and any out-of-pocket costs.

Applying for hospice services. 

To apply for hospice care:

• Confirm eligibility through your doctor’s certification of terminal illness.
• Choose a Medicare-approved hospice provider.
• Sign a statement opting for hospice care over curative treatment.

Contact Crossroads to apply for hospice services.

Medicare hospice eligibility guidelines FAQ. 

Does Medicare cover 24-hour in-home hospice care?

Medicare covers continuous home care during a crisis that requires skilled nursing. However, 24-hour in-home care is rare. While hospice teams are on-call 24/7, family caregivers often provide much of the daily care.

Does Medicare cover hospice in nursing homes?

Yes, hospice services can be provided in nursing homes, long-term care facilities, private homes, or hospitals, depending on the patient’s needs.

Can you receive skilled nursing care and hospice care simultaneously?

Medicare prohibits concurrent skilled nursing and hospice care for the same diagnosis. Skilled care for unrelated conditions may still be covered.

What happens if a patient outlives the six-month prognosis?

Patients can remain on hospice care if the hospice team recertifies their eligibility after each benefit period.

What are the Medicare guidelines for hospice respite care?

Medicare covers multiple short-term inpatient respite care stays (up to 5 days each) within a single billing period, as long as they are deemed necessary and arranged by the hospice team. Patients are responsible for a 5% copayment of the Medicare-approved amount, which cannot exceed the annual inpatient hospital deductible. These stays provide relief for family caregivers while maintaining the patient's professional care.

Help is available.

If you or a loved one may be eligible for hospice care or have questions about hospice Medicare criteria, reach out to Crossroads Hospice & Palliative Care at 855-327-4677 or via one of the contact options in the Help Bar above. We are available to answer questions 24 hours a day, 7 days week, 365 days a year, and will come to you wherever you call home. Browse our service areas to find professional hospice care near you.