Understanding What Medicare Covers Under the Hospice Benefit

CaregiverPushingHospicePatientWhen an aging loved one has a life-limiting illness, hospice is usually a welcome addition to their care. But many families are unaware of the benefit or unclear what is covered.

Your friends at Seniors in Transitions offer this quick overview of what your Hospice Medicare benefit encompasses:

  • Routine care for pain and symptom management is covered at 100%. This includes an interdisciplinary team of professionals made up of physicians, nurses, aides, chaplains, and social workers. It may also include a variety of therapies from massage to music.
  • Medications needed to manage pain and symptoms are typically covered at 100%.
  • Equipment and supplies a patient requires due to the life-limiting illness. A few examples would be oxygen or a hospital bed.
  • If the patient has a crisis where pain and symptoms cannot be managed, a short-term stay at an inpatient hospice center will be fully covered. Once the pain is managed, the patient can return home. 
  • Continuous care is also a short-term benefit under hospice. It can be provided in a patient’s home or at an inpatient center. The hospice team brings 24-hour care in to help manage the crisis until pain and symptoms are back under control.
  • If the primary caregiver becomes too exhausted to care for their loved one, hospice will pay for 95% of a respite stay at a nursing community.Bereavement and grief support for both the patient and the family are a part of the Medicare hospice benefit.

These items are typically NOT covered by Medicare:

  • Room and board whether the patient lives at home, in a senior living community, or skilled nursing home. If the patient receives Medicaid for room and board, these costs will typically continue to be covered. For those without Medicaid, room and board must be privately paid.
  • Medications and equipment for conditions unrelated to the life-limiting illness.

If you would like to learn more about the Medicare Hospice Benefit, Medicare.gov has a free guide (http://www.medicare.gov/Pubs/pdf/02154.pdf) you can download. 

Have you used hospice services before? Do you have any advice for families considering hospice?

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