Thinking about end-of-life care isn’t something anyone wants to do. Whether you’re planning for yourself or helping a loved one with a life-limiting illness, these difficult conversations are necessary. Lots of questions will come up, but one tends to stand out among the others: how long will Medicare pay for hospice care? Understanding insurance coverage is essential, especially since Medicare plans offer a comprehensive hospice benefit. Let’s talk through Medicare’s hospice benefit and how long your loved one can take advantage of it.

What Is Hospice Care?

Before we can get into the specifics of hospice coverage, it’s helpful to understand the basics of this type of care. In short, hospice is a specialized type of care for individuals with a terminal illness. The focus is on managing symptoms and improving the quality of life for the remaining time, not curing the illness. It’s a holistic approach that addresses the physical, emotional, and spiritual needs of the patient, while also providing support for their family and caregivers.

Does Medicare Pay for Hospice?

Yes, Medicare Part A includes a comprehensive hospice benefit. If your loved one is enrolled in Medicare Part A, they’ll also need to meet these eligibility criteria:

Doctor Certification—Patients need a certification from their doctor or hospice medical director stating that they have a terminal illness with a life expectancy of six months or less if the illness runs its normal course.
Signed Statement—Patients must then sign a statement choosing hospice care instead of other Medicare-covered treatments for their terminal illness. This means the patient agrees to stop curative treatment and focus on comfort care.

How Long Does Medicare Cover Hospice?

A common misconception is that Medicare’s hospice benefit is limited to only six months. While the initial certification is for a six-month prognosis, the coverage can extend much longer if the patient continues to meet the eligibility criteria.

Initial Coverage Periods

Medicare hospice coverage is structured in benefit periods. It begins with two initial 90-day periods:

First 90-Day Period—After the initial certification, the patient is covered for the first 90 days of hospice care. During this time, a wide range of services may be requested to manage symptoms and provide support.
Second 90-Day Period—Towards the end of the first period, the hospice team will reassess the patient’s condition. If the patient’s life expectancy is still six months or less, they can be recertified for another 90 days of care.

Extended Coverage Periods

Patients aren’t penalized for living beyond their six-month prognosis. After the initial two 90-day periods, coverage can be renewed for an unlimited number of 60-day benefit periods, as long as a doctor or nurse practitioner certifies the patient still has a life expectancy of six months or less. There is no lifetime limit under Medicare.

Coverage for Palliative Care Under Medicare

While palliative care is often discussed alongside hospice, the two should not be confused. Palliative care has similar goals and focuses on comfort and quality of life. However, it can be provided at any stage of illness and might be received alongside curative treatment.

Medicare Part B may cover palliative care services, such as doctor visits, physical therapy, and symptom management treatments, even if the patient is still seeking a cure for their illness. Once a patient elects the Medicare hospice benefit, their care shifts entirely to comfort and is covered under Part A.

What Medicare’s Hospice Benefit Covers (and What It Doesn’t)

The Medicare hospice benefit is designed to be all-inclusive. That means your loved one can continue to receive the best possible care at no cost to them. In general, Medicare covers everything related to a patient’s terminal diagnosis, such as:

Physician and nursing services
In-home medical equipment
Medical supplies
Prescription drugs
Hospice aide and homemaker services
Physical and occupational therapy
Social work services
Spiritual counseling

What Medicare Does Not Cover

Once your loved one elects to begin their hospice benefit, Medicare stops covering anything intended to cure the terminal illness. They will no longer be eligible to receive prescription drugs to cure the illness, instead receiving medication for symptom control only. Other things that may no longer be covered include:

Care from providers not set up by their hospice team
Room and board in a residential facility
Emergency room visits or inpatient care, unless coordinated by hospice
Ambulance transportation, unless coordinated by hospice

Find the Support Your Family Needs at Agape Hospice NW

Navigating end-of-life care decisions is emotionally taxing. However, understanding Medicare’s hospice benefit can bring significant peace of mind for you and your loved one. At Agape Hospice NW, we’re proud to provide exceptional in-home hospice care for patients in Portland, OR. Our services are at no cost to you, and we can help you understand the benefits of Medicare Part A. Get in touch with us today to learn more about how we can help.