The word hospice can bring up a lot of emotions—and also a lot of questions.
One of the most important questions is:
What happens to your Medicare coverage when you choose hospice care?
Many people assume that entering hospice means giving up their existing Medicare insurance or that all medical care must now go through hospice.
That isn’t the case.
Understanding how Medicare hospice coverage works can help patients and their families avoid unnecessary confusion, unexpected bills, and disruptions in care during an already important time.
First, What Is Hospice Care?
Hospice is specialized care for people who are terminally ill and have chosen comfort-focused care rather than treatment intended to cure their terminal illness.
To qualify for the Medicare hospice benefit, a hospice doctor and the patient’s regular doctor, if applicable, must certify that the patient is terminally ill with a life expectancy of six months or less if the illness follows its normal course.
The patient chooses hospice by signing a Hospice Election Statement.
And something many people may not realize:
Living longer than six months does not automatically mean hospice ends.
Medicare provides two 90-day hospice benefit periods, followed by an unlimited number of 60-day benefit periods. Hospice may continue as long as the patient remains eligible and is properly recertified.
Who Pays for Hospice Care?
For Medicare beneficiaries who elect hospice, Original Medicare covers the Medicare-approved hospice care related to the terminal illness and related conditions—even if the beneficiary is enrolled in a Medicare Advantage plan.
Depending on the patient’s terminal illness and related conditions, the hospice plan of care may include:
• Doctor and nursing services
• Medical equipment and supplies
• Medications for pain relief and symptom management
• Physical, occupational, and speech therapy
• Hospice aide and homemaker services
• Social services
• Dietary counseling
• Spiritual and grief counseling
• Short-term inpatient care for pain and symptom management
• Short-term respite care for caregivers
• Other Medicare-covered services recommended by the hospice team to manage pain and symptoms related to the terminal illness
For covered hospice services from a Medicare-approved hospice provider, there is generally no deductible and no cost for most hospice care.
There are limited exceptions.
A beneficiary may pay up to $5 for certain outpatient prescriptions for pain and symptom management and may pay 5% of the Medicare-approved amount for inpatient respite care.
Room and board generally isn’t covered when hospice is provided where someone lives, such as at home, in an assisted living facility, or in a nursing home.
What If You Have a Medicare Advantage Plan?
This is an especially important distinction.
Electing hospice does not require you to give up your Medicare Advantage plan.
According to Medicare, once the hospice benefit begins, Original Medicare covers the care related to the terminal illness and related conditions—even when the beneficiary remains enrolled in Medicare Advantage.
The Medicare Advantage plan remains active and can continue covering healthcare needs that are unrelated to the terminal illness and related conditions.
For Medicare Advantage HMO members, this means continuing to follow the plan’s coverage rules and using the plan’s contracted physicians, specialists, hospitals, and assigned medical group for care outside of hospice.
The Medicare Advantage plan may also continue providing additional benefits included in the plan, such as dental or vision coverage, according to the terms of the plan.
You continue paying any applicable Medicare Advantage plan premiums and other required costs to keep the coverage active.
What If You Have a Medicare Supplement and Part D?
The same principle is important for beneficiaries who have Original Medicare together with a Medicare Supplement and standalone Medicare Part D Prescription Drug plan.
Electing hospice does not mean these policies should be cancelled.
The hospice benefit covers care associated with the terminal illness and related conditions.
The beneficiary may still need medical care for other health conditions, and their existing Medicare and Medicare Supplement coverage remains important for those Medicare-covered services.
The Part D Prescription Drug plan may also continue to be needed for medications that are unrelated to the terminal illness and therefore aren’t covered by the hospice benefit.
Keep your existing Medicare coverage in place while receiving hospice care.
Hospice provides an additional Medicare benefit for the terminal illness. It does not replace the need for healthcare coverage for everything else.
Hospice Does Not Mean All Medical Care Stops
This is perhaps the most important part to understand.
A person receiving hospice care may continue to have completely separate healthcare needs.
Someone receiving hospice for one terminal illness may still need treatment for other medical conditions, including visits with their regular physicians or specialists, diagnostic testing, imaging, medications, or other medically necessary care.
The key is understanding which coverage applies to which care.
Care related to the terminal illness and related conditions is coordinated through the hospice team and covered under the Medicare hospice benefit.
Care unrelated to the terminal illness continues through the beneficiary’s other Medicare coverage.
For someone enrolled in a Medicare Advantage HMO, that means continuing to follow the plan’s rules and established provider network for unrelated care.
For someone with Original Medicare, a Medicare Supplement, and Part D, those coverages continue serving their respective purposes for healthcare and prescriptions outside of the hospice benefit.
Before Receiving Care Outside Your Hospice Plan
This is another area where misunderstandings can become expensive.
Once hospice has been elected, care for the terminal illness generally needs to be provided by or arranged through the chosen hospice provider.
That can include hospital care, emergency care, ambulance transportation, medications, equipment, and other services associated with the terminal illness.
Medicare specifically advises beneficiaries to contact their hospice team before receiving these services, unless the care is unrelated to the terminal illness.
Otherwise, the beneficiary could become responsible for the cost.
Your hospice provider can also give you an addendum to the Hospice Election Statement listing items, services, and medications it has determined are not related to your terminal illness and related conditions, including an explanation of why.
This can be extremely helpful in understanding which care belongs under hospice and which care should continue through your other Medicare coverage.
Families and Representatives Need to Understand How the Coverage Works Too
As we age, there may come a time when a spouse, adult child, family member, caregiver, or person holding power of attorney begins helping manage healthcare.
That help can be invaluable.
But stepping in to help also means learning how the patient’s existing healthcare coverage works.
Hospice does not eliminate the need to understand the patient’s Medicare Advantage plan, medical group, Medicare Supplement, Part D coverage, physicians, specialists, and established healthcare relationships.
Before arranging doctors’ appointments, laboratory work, imaging, specialist care, medications, or other services unrelated to the terminal illness, find out how those services need to be accessed under the patient’s existing Medicare coverage.
For a Medicare Advantage HMO member, that may mean working through the assigned medical group, primary care physician, contracted specialists, and appropriate referrals or authorizations.
For someone with Original Medicare and a Medicare Supplement, it means continuing to use that coverage appropriately for Medicare-covered care outside of hospice.
And for prescriptions unrelated to the hospice diagnosis, the beneficiary’s Part D coverage may continue to apply.
A decision intended to simplify someone’s care can create an entirely different problem if the existing coverage structure isn’t understood first.
One More Important Hospice Fact
Choosing hospice isn’t necessarily an irreversible decision.
A beneficiary has the right to stop hospice care at any time.
If circumstances change and the individual wants to pursue treatment intended to cure the terminal illness again, the hospice benefit can be revoked.
A beneficiary may also be able to elect hospice again later if they meet Medicare’s eligibility requirements.
Knowledge Helps Protect Continuity of Care
Hospice can provide extraordinary support for patients and their families.
But receiving hospice care does not mean the patient’s other healthcare coverage should be disrupted.
Keep existing Medicare coverage in place.
Allow the hospice team to coordinate the care associated with the terminal illness and related conditions.
And for healthcare needs unrelated to the terminal illness, learn how the patient’s existing Medicare coverage works before scheduling appointments, laboratory testing, imaging, specialist care, or other services.
This becomes especially important when a family member, caregiver, or representative begins helping someone else manage their healthcare.
You don’t have to know everything about Medicare.
But before changing how someone’s established care is being accessed, ask questions and understand how their coverage works first.
Sometimes one conversation can prevent unnecessary confusion, interrupted care, and unexpected medical bills.
The goal is simple: protect continuity of care, keep existing coverage in place, and understand how to use each benefit correctly.
For complete information about Medicare hospice coverage:
Medicare.gov – Hospice Care
https://www.medicare.gov/coverage/hospice-care
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