Hospice care provides support for individuals facing terminal illnesses, focusing on comfort and quality of life rather than curative treatment. For many families, understanding how Medicaid and Medicare address hospice coverage is vital for planning and decision-making.
Does Medicare cover hospice care?
Yes, Medicare does cover hospice care through its Medicare Part A program. This benefit is available for individuals diagnosed with terminal illnesses, with a life expectancy of six months or less, as certified by a doctor. Coverage begins after the patient elects hospice care over curative treatments.
What Medicare covers
Medicare pays for a wide range of hospice-related services to ease the burden of terminal illness. These include:
- Visits from a hospice care team, including doctors, nurses, and social workers.
- Prescription medications for symptom control and pain relief.
- Physical, speech, and occupational therapy.
- Durable medical equipment like wheelchairs and oxygen.
- Home health aide and homemaker services.
- Short-term inpatient care for symptom management or respite care for caregivers.
- Grief and spiritual counseling for both the patient and their family.
Limits to Medicare coverage
Medicare excludes certain services even under its hospice benefit, such as:
- Treatments aimed at curing the terminal illness.
- Room and board costs in hospice facilities or nursing homes.
- Ambulance transportation or hospital care unrelated to the terminal illness.
- Prescriptions not linked to symptom relief or palliative care.
Cost considerations
While most hospice services are fully covered, patients may pay up to $5 for prescription drugs for pain and 5% of Medicare-approved costs for respite care​.
Does Medicaid cover hospice care?
Medicaid, a state-federal partnership program, also offers hospice benefits, but coverage can vary by state. States that opt to provide hospice care must meet minimum federal requirements, ensuring comprehensive support.
What Medicaid covers
Similar to Medicare, Medicaid offers broad coverage, which includes:
- A multidisciplinary hospice team comprising doctors, nurses, and aides.
- Prescription medications for pain management.
- Medical equipment rentals and purchases.
- Therapy services (physical, occupational, and speech).
- Grief counseling and spiritual support.
- Short-term inpatient care and respite care services.
- At least 210 days of hospice care.
State variability
Medicaid eligibility and hospice service duration depend on state-specific policies. For instance, while some states define terminal illness as a life expectancy of six months or less, others, like Colorado, may allow for up to nine months​.
Cost considerations
Medicaid patients typically face no copayments or deductibles for hospice care, including room and board if care is provided in a nursing home or assisted living facility. This feature is an advantage over Medicare​.
Eligibility requirements for Hospice care
Medicare eligibility
To qualify for Medicare-covered hospice care, patients must:
- Be enrolled in Medicare Part A.
- Receive a terminal diagnosis certified by a hospice doctor.
- Elect palliative care (comfort-focused) instead of curative treatments.
- Complete a hospice election form acknowledging this choice.
Medicaid eligibility
Medicaid hospice eligibility aligns with state regulations. Patients generally need:
- A terminal diagnosis certified by a hospice physician.
- A detailed hospice plan of care.
- A completed hospice election statement. Patients must also waive curative Medicaid services related to their terminal condition​.Â
How to supplement coverage
For individuals who do not qualify for Medicare or Medicaid, or if their plans do not fully cover their needs, other options include:
- Private health insurance plans offering hospice benefits.
- Nonprofit hospice organizations providing charity-based care.
- Out-of-pocket payments or long-term care insurance​.
- Veteran health care.
- Reverse mortgage.
