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Medicare and Hospice Benefits

Important Facts About Hospice

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If your loved one is eligible for Medicare, his or her hospice care might be covered. Your loved one must meet all of the following requirements: Eligible for Medicare Part A (Hospital Insurance). A doctor and the hospice medical director certify that your loved one is terminally ill and has 6 months or less to live.

Medicare and Hospice Benefits ~

You can get Medicare Hospice benefits when you meet all of these conditions:

  • You’re eligible for Medicare Part A (Hospital Insurance).
  • Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course.
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.)
  • You get care from a Medicare-approved hospice program.

What Medicare Won’t Cover ~

When you choose hospice care, you’ve decided that you no longer want care to cure your terminal illness and/or your doctor has determined that efforts to cure your illness aren’t working. Medicare won’t cover any of these once you choose hospice care:

  • Treatment intended to cure your terminal illness. Talk with your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
  • Prescription drugs to cure your illness (rather than for symptom control or pain relief)
  • Care from any hospice provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small co-payment for the respite stay.

How Hospice Works ~

Hospice is a special way of caring for people who are terminally ill, and for their families. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness. Hospice is a program of care and support for people who are terminally ill. The Texas Department of Aging and Disability Services (DADS) Regulates and Licenses Texas Hospice programs.

Here are some important facts about Hospice:

  • Hospice helps people who are terminally ill live comfortably.
  • Hospice isn’t only for people with cancer.
  • The focus is on comfort, not on curing an illness.
  • A specially trained team of professionals and caregivers provide care for the “whole person,” including his or her physical, emotional, social, and spiritual needs.
  • Services may include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition(s).
  • Care is generally provided in the home.
  • Family caregivers can get support.

Hospice is a program of care and support for people who are terminally ill. Here are some important facts about hospice:

  • Hospice helps people who are terminally ill live comfortably.
  • Hospice isn’t only for people with cancer.
  • The focus is on comfort, not on curing an illness.
  • A specially trained team of professionals and caregivers provide care for the “whole person,” including his or her physical, emotional, social, and spiritual needs.
  • Services may include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related condition(s).
  • Care is generally provided in the home.
  • Family caregivers can get support.

Your doctor and the hospice team will work with you and your family to set up a plan of care that meets your needs. Your plan of care includes hospice services that Medicare covers. For more specific information on a hospice plan of care, call your area hospice organization.

If you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness. You and your family members are the most important part of the team. Other people on the team may include:

  • Doctors
  • Nurses or nurse practitioners
  • Counselors
  • Social workers
  • Physical and occupational therapists
  • Speech-language pathologists
  • Hospice aides
  • Homemakers
  • Volunteers

In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week to give you and your family support and care when you need it.

A hospice doctor is part of your medical team. Your regular doctor or a nurse practitioner can also be part of this team as the attending medical professional to supervise your care. However, only your regular doctor (not a nurse practitioner that you’ve chosen to serve as your attending medical professional) and the hospice medical director can certify that you’re terminally ill and have 6 months or less to live.

The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay.

What You Pay For Hospice Care ~

Medicare pays the hospice provider for your hospice care. There’s no deductible.

You’ll pay:

  • No more than $5 for each prescription drug and other similar products for pain relief and symptom control.
  • 5% of the Medicare-approved amount for inpatient respite care.

For example, if Medicare pays $100 per day for inpatient respite care, you’ll pay $5 per day. The amount you pay for respite care can change each year.

How Long You Can Receive Hospice Care?


Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor re-certifies that you’re terminally ill.

Important: Hospice care is given in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical director or other hospice doctor must re-certify that you’re terminally ill, so you can continue to get hospice care. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60 day period ends. Source:www.medicare.gov

Additional Hospice and Home Health Resources ~


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