Medicare and the Cost of Hospice

Does Medicare Pay for Hospice?

When a cure isn’t an option, most patients opt for comfort at home, among familiar things and familiar people. The Medicare Hospice Benefit provides access to services that address the physical, emotional and spiritual needs that accompany a terminal illness.  

You Qualify for the Medicare Hospice Benefit If You Meet These Conditions 

• You are eligible for Medicare Part A (hospital insurance). See if you're eligible at Medicare.gov
• Your doctor and the hospice physician certify that your life expectancy is six months or less. 
• You wish to receive palliative care for comfort, not treatments aimed at a cure. 

You may stop hospice care at any time. As long as you meet the eligibility guidelines, you can always return to hospice care. Individuals who exceed the life expectancy can receive hospice services beyond six months. There is no penalty for these extended benefits. At certain intervals, a hospice physician will need to re-certify that the prognosis remains six months or less. 

How Hospice Works 

VITAS will assign a specially trained team to help you cope with your illness. The team includes:  

• A hospice physician with expertise in pain and symptom management 
• A nurse to supervise the plan of care, provide hands-on care, and train patients and loved ones in appropriate caregiving 
• A hospice aide for personal assistance 
• A chaplain to provide pastoral care 
• A social worker to address emotional, financial and social stresses

The Role of Your Personal Doctor 

Although a doctor is part of the VITAS hospice team, your personal doctor can continue to direct your care. VITAS welcomes the participation of personal physicians in the management of a patient’s care. 

What Medicare Hospice Benefits Cover

The Medicare Hospice Benefit covers up to 100 percent of VITAS’ services, with no deductible or copayment for services provided related to the patient’s terminal illness. Products and services in the hospice plan of care include:

• All prescription drugs, over-the-counter medications, medical equipment, and supplies related to the patient’s terminal illness and necessary for enhanced comfort, as designated in the plan of care
• If indicated for palliative purposes, physical therapy, occupational therapy, speech therapy, and dietary counseling
• Lab and other diagnostic tests necessary to achieve optimum palliative care
• Inpatient care for pain and other symptoms that cannot be managed at home
  
• Bereavement services for the family for at least one year after a loss
  

Medicare continues to pay for covered benefits for any health problems that are not directly related to the terminal illness. The hospice medical team determines what care is—and is not—directly related to the terminal illness. To ensure you are covered, contact your hospice team before receiving or scheduling new medical services or procedures.

Comparing Hospice Providers

All hospice organizations are reimbursed in the same way, so they do not compete on cost. It is the quality of service that differentiates one hospice from another. Consider these questions when choosing a hospice:

• Does the hospice provider have the resources and facilities to provide the most appropriate level of care?
• Does the hospice employ full-time physicians who can dedicate all their time to caring for hospice patients and families?
• Does the hospice team have systems in place to be responsive in your time of need?

We’re Here for You

When someone becomes seriously ill, it can be difficult to know where to turn.

VITAS can help.

Download our free hospice discussion guide.

For more information, call 800.723.3233.