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You can either receive hospice care at an inpatient facility or in your home. Hospice care is the kind of care that is given to you when you have a life expectancy of 6 months or less. You may receive this kind of care if you choose it over treatment for a terminal illness.
So a common question many people have is, “does Medicare cover hospice at home?” In this article, we answer that question in clear, plain English. You will also find the average costs of hospice and other helpful info.
Does Medicare Cover Hospice At Home?
The short answer is yes; Medicare will cover the cost of home-based hospice care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home-based hospice care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for home-based hospice care. Coverage for home-based hospice care is provided by Medicare Part A. Medicare Part A provides coverage for home-based hospice care as long as your hospice provider is enrolled in Medicare and accepts Medicare coverage.
Medicare Part A provides coverage for hospice care if your healthcare provider believes that your life expectancy is not longer than 6 months due to your terminal illness. You are also obliged to sign a statement that confirms that you:
- Choose to have palliative care
- Do not want to continue seeking treatment to cure your illness
- Choose hospice care rather than other Medicare-approved services to treat your illness
Though most people in hospice care have a life expectancy of fewer than six months, some people live longer than that. After six months, Medicare Part A will still provide coverage for your hospice care as long as you need it. Medicare Part A will cover two 90-day benefit periods. Once that is done, you can recertify for an unlimited 60-day benefit period.
Medicare Part A provides coverage for the following hospice-related services:
- Dietary counseling along with other nutrition services
- Medical supplies and equipment
- Prescription medications to relieve symptoms or control pain
- Doctor and nursing services
- Social work services for both the patient and the family
- Semi-private room
- Occupational therapy
- Physical therapy
- Speech-language pathology
- Short-term respite care (up to five days at a time)
Medicare Part A may also provide coverage for treatment for other non-terminal illnesses and medical conditions that you have while under hospice care.
For home-based hospice care, Medicare will not cover the “room and board” portion.
Part C and Part D Coverage for Hospice at Home
Medicare Advantage plans (Medicare Part C) also provide coverage for home-based hospice care. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part D provides coverage for medications that are not related to the patient’s terminal condition. However, the healthcare provider must first inform your Medicare Part D plan.
How Much Does Home-Based Hospice Care Cost?
Home-based hospice care can cost around $150 per day. This cost will vary from one hospice provider to another.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover dental?