Does Medicare or Medicaid Cover Hospice?
Hospice care is medical support for patients whose life expectancy is 6 months or less. End-of-care medical costs in some states total a whopping $24,408.38, so some people may wonder how they can afford hospice. With over 65,748,297 older adults on Medicare, it’s not a stretch to imagine some of those recipients may eventually need hospice care. But does it cover hospice? Can Original Medicare go toward covering the expenses? What about Medicaid? Here’s what you should know.
What Is Hospice?
Hospice care, or end-of-life care, is medical support for individuals with terminal illnesses during the final stages of life. The aim of hospice is not to find a cure. Rather, the goal is to focus on symptom management and maintain quality of life. Patients typically receive hospice care within the comfort of their own homes. However, an individual can also receive hospice care in other facilities, such as nursing homes or retirement communities.
Routine Home Care
This level of care is provided when the patient isn’t in a state of medical crisis. The team of healthcare professionals typically includes hospice physicians, registered nurses, social workers, spiritual counselors, and home health aides. They collectively aim to provide a combination of custodial and medical services customized to meet the unique needs and preferences of the patient. The goal is to maintain the highest possible quality of life within a familiar environment, such as the patient’s home. The care team also assists with daily living activities such as dressing, bathing, skincare, haircare, and changing bed linens. In some cases, they may also help with tasks like bandage changes and incontinence care.
Continuous Home Care
Continuous home care is provided during periods of crisis when the patient is experiencing uncontrolled symptoms that require more intensive care. This level of care involves a skilled hospice team that provides continuous nursing care for at least eight hours a day. Their goal is to address and manage acute symptoms. Continuous home care allows individuals to receive the necessary support in their home environment. The nurse or healthcare professional may monitor vital signs, administer medications, manage pain, and even provide emotional support. The care team works together to prevent unnecessary hospital admissions and provide maximum comfort for the patient.
General Inpatient Care
When symptoms can’t be managed effectively in a home setting, a patient may instead receive general inpatient care. This type of care is provided in an inpatient facility, such as a hospice inpatient unit, hospital, or skilled nursing facility. General inpatient care is intended for patients requiring more intensive medical attention, including pain and symptom management until their condition stabilizes. General inpatient care offers a higher level of medical support in a facility setting. The primary goal of GIP is to manage acute medical symptoms that can’t be controlled at the routine home care level. The care team—which generally includes physicians, nurses, social workers, and spiritual counselors—collaborates to provide intensive medical care, pain management, and emotional support.
Respite Care
Respite care provides temporary relief to the primary caregiver by allowing the patient to temporarily receive care in an inpatient facility, such as a hospice inpatient unit or hospital. This type of care is typically short-term. The caregiver has a chance to recharge while the patient receives the care and support they need. Services provided during respite care for hospice patients usually include medical care and symptom management, assistance with daily living activities, nutritional services, and emotional support. This ensures that the patient continues to receive the necessary care and attention even in the absence of their primary caregiver.
What Is Medicare?
Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. Medicare primarily serves individuals aged 65 and older. Eligible individuals are automatically enrolled in Medicare Part A (hospital insurance) when they turn 65, provided they meet certain eligibility criteria.
Medicare consists of different parts that provide coverage for various healthcare services:
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance): Covers outpatient care, physician services, preventive services, mental health care, and durable medical equipment.
- Part C (Medicare Advantage): Private insurance plans that offer coverage combining Parts A and B. Often include additional benefits such as vision, hearing, and dental.
- Part D (Prescription Drug Coverage): Offers prescription drug coverage through private insurance plans.
Does Medicare Cover Hospice?
Yes, Medicare does cover hospice care. Medicare provides a comprehensive hospice benefit under Medicare Part A, which is the hospital insurance component of the program. The hospice benefit offers support and services to individuals with a terminal illness who have a life expectancy of six months or less. Additionally, hospice care under Medicare can be provided in various settings, including the patient’s home, a hospice inpatient facility, a hospital, or a skilled nursing facility.
Eligibility
To qualify for Medicare hospice benefits, an individual must meet the following criteria:
- Must be enrolled in Medicare Part A.
- Both your hospice doctor and your regular doctor must certify that you have a prognosis of six months or less.
- You must agree to palliative care instead of curative treatment.
- You must sign a statement agreeing to hospice care instead of other Medicare-covered treatments for your terminal illness.
Covered Services
Medicare hospice benefits cover a range of services, including:
- Nursing care
- Physician services related to the patient’s terminal illness
- Medications for pain relief and symptom management
- Medical equipment and supplies
- Counseling services for the patient and their family
- Short-term inpatient care for pain and symptom management
- Respite care to provide temporary relief for the primary caregiver
- Dietary counseling
- Grief counseling for loved ones
- Social worker services
- Hospice aide and homemaker services
Duration of Coverage
Medicare covers hospice care for as long as the patient’s condition remains terminal and the individual continues to meet the eligibility criteria. A doctor will assess the need for hospice services on an ongoing basis.
What Is Medicaid?
Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals, including children, disabled individuals, pregnant women, and older adults. This program covers a wide range of healthcare services, which includes some long-term care options. To apply for Medicaid, contact your State Medical Assistance (Medicaid) office.
Does Medicaid Cover Hospice?
Yes, Medicaid does cover hospice care for terminally ill individuals. Medicaid’s hospice benefits are similar to those that Medicare provides, offering comprehensive end-of-life care for individuals with a terminal illness.
Eligibility
Eligibility for Medicaid hospice benefits varies by state. Individuals must meet both the state-specific criteria for Medicaid and the criteria for hospice care. Typically, patients must meet the following requirements:
- Must be enrolled in Medicaid.
- A physician must certify that the patient has a prognosis of six months or less.
- The patient must fill out an election statement with their chosen hospice.
- They must acknowledge that they are revoking curative treatments and choosing hospice.
- A hospice care plan must be established before the patient can receive services (according to Medicaid.gov).
Covered Services
Medicaid hospice benefits cover a range of services, including:
- Nursing care.
- Physician services related to terminal illness.
- Medications for pain relief and symptom management.
- Medical equipment and supplies.
- Short-term inpatient care for pain and symptom management.
- Respite care.
- Chaplain support.
- Grief counseling.
- Physical, speech, and occupational therapy.
- Social worker services.
- Hospice aide services.
Duration of Coverage
Like Medicare, Medicaid covers hospice care for as long as the patient’s condition remains terminal and the individual continues to meet the eligibility criteria. A physician or doctor will continue to assess whether or not there’s an ongoing need for hospice care.
More Hospice Resources
Individuals and their families should be aware of the specific details of Medicare and Medicaid hospice coverage. If you or a loved one is considering hospice care, contacting the respective program (Medicare or Medicaid) or the hospice provider directly can clear up any confusion and help individuals receive the necessary support during a challenging time.
Need more help with hospice care? Then start with these great resources:
Senior Resource Glossary of Hospice Terms
Popular Articles About Hospice Care
Originally published December 17, 2024
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