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Medicare Requirements for Hospice

Medicare is the federally-administered health care benefit for the elderly and disabled in the United States. The elderly and disabled are especially at risk to many terminal illnesses and disease. If diagnosed with one of these diseases, Medicare beneficiaries have a choice to either continue with treatment or to begin hospice care.

  1. Medicare Coverage

    • In order to receive the hospice benefit provided by Medicare, the beneficiary must have Part A, the inpatient hospital benefit, or a Medicare private health plan.

    Medicare-Certified Agency

    • The hospice agency that the beneficiary receives care from must be Medicare-certified.

    Certified Terminal Illness

    • For Medicare to fully cover hospice care, the patient’s doctor and the medical director at the hospice must certify the patient’s illness as terminal. Terminal means that the patient is expected to live for six months or less.

    Palliative Care Statement

    • The patient must also sign a statement that says they agree to terminate any curative treatment for their illness, and to have Medicare pay for palliative care, which will treat the symptoms of the illness and cover pain management. Any treatment for health problems not related to the terminal illness will still be covered.

    Hospice Care Team

    • One of the goals of hospice care is to treat the whole patient, including any physical, emotional, social, or spiritual needs. For this reason, the beneficiary must have a hospice care team and staff to help the beneficiary and their family through the hospice process. This team can consist of doctors, therapists, social workers, hospice aids, and others.

    Plan of Care

    • The doctor and hospice medical director must draft a plan of care that outlines the hospice treatment plan.

    Location Requirements

    • Medicare does not require recipients to receive hospice care in the home if the hospice team and the beneficiary’s doctor determine it would be better for the beneficiary to stay in an inpatient facility. In this case, Medicare beneficiaries are eligible to receive hospice care in inpatient hospital hospice facilities. These arrangements will be made by the hospice medical team.

    Payments

    • Beneficiaries will only pay $5 for each prescription drug needed while in hospice care and 5 percent of any Medicare-covered inpatient respite care. Respite care refers to needing an aid to look after the patient to give the caregivers a rest. Besides these costs, hospice is covered 100 percent by Medicare as long as the beneficiary seeks treatment from a Medicare-certified agency.

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