NW Florida Medicare Serving the Panhandle

Medicare Hospice Benefits: What to Expect if the Worst Happens

It’s an understatement to say that preparing for hospice is stressful, but it’s even worse if you don’t understand your Medicare hospice benefits. Even though your Medicare plan is meant to cover your needs during the last few months of your life, it can be too much to have to navigate the process. 

Too many patients don’t want to think about terminal illness, so they don’t prepare for it. This leaves them having to try to understand the process and Medicare benefits during an incredibly emotional time. 

In this article, we discuss the most important aspects of your hospice coverage. We will clarify what Medicare does and does not cover in relation to hospice care. Continue reading so you’re prepared for the worst. 

Medicare Hospice Eligibility

To be eligible for Medicare hospice benefits, you have to be covered under Part A of your medicare plan. Medicare Part A includes coverage for inpatient hospital stays and other care facilities. Additionally, your doctor must deem you terminally ill and your life expectancy may not be more than 6 months. 

The determination of your life expectancy is not a number that is set in stone. It’s a doctor’s educated estimation based on their knowledge of the illness. The doctor takes into account how the illness affected other patients under normal conditions. 

As part of your eligibility for medicare hospice, you must contribute your monthly premiums for Medicare Part A, and Part B. Medicare Part B provides coverage for certain services and care.

You are responsible for any copayments for prescription drugs. You are also responsible for 5% of the cost of inpatient respite care. 

What do My Medicare Hospice Benefits Cover?

A hospice medical director will discuss coverage as part of your hospice benefits. This is a one-time opportunity where the director will review your care and symptom management options. This helps you understand your options and decide if it is a process you want to pursue.

The treatment options under Medicare hospice depend on your specific illness and condition. Coverage often includes doctor and nursing services, medical supplies, medications, physical therapy, and other forms of care. 

These services are commonly provided at a hospice inpatient facility. However, most patients receive care in their homes. Medicare will cover these costs as long as you receive them from an approved provider.

What Is NOT Covered by Medicare Hospice Benefits?

Medicare benefits for hospice don’t cover treatments or medications meant to cure your condition. This is because of the decision to undergo Medicare hospice care. This choice means that you and your doctor agree that your condition is untreatable.

Instead of treating your condition, you’ve elected to focus on staying as comfortable as possible with your remaining time. However, keep in mind that you can discontinue hospice care whenever you choose. 

Additionally, Medicare will not cover prescription drugs that aren’t related to your condition. It will also not cover care that comes from outside of hospice.

While room and board are also not typically covered, it is still possible to receive coverage for a short-term stay. This depends on if the stay is deemed necessary by your hospice team. If you do receive coverage, you will be responsible for a small copay. 

You are also responsible for the cost of any inpatient or outpatient care provided to treat your condition. This includes ambulance transportation. The only exception to this is if it is arranged by your hospice team. 

How Long Do My Medicare Benefits Last for Hospice?

As we said, Medicare hospice care is for terminally ill patients with a life expectancy no longer than 6 months. Your hospice care starts with a 90-day benefit period. After this 90-day period, you will need a hospice doctor to recertify that your condition is the same. 

If you surpass the 6-month mark, you will need recertification from a hospice doctor that your life expectancy is the same. Once received, your coverage will extend for a 60-day period. You may receive an unlimited number of 60-day benefit periods as long as you receive this recertification. 

Can I Drop Hospice Care?

You may choose to stop hospice care if you go into remission or your condition improves. You have the option to drop hospice care as part of your medicare plan at any time. You will be required to indicate an end date for your care by signing a form. 

How Does My Medicare Plan Affect Other Treatments?

Hospice care benefits cover needs relating to your terminal illness. However, other issues may arise that are not related to this illness. The good news is that your original Medicare plan will cover treatments that are not related to your terminal illness.

You will still be responsible for deductibles for these services. Keep in mind, if you continue with a Medicare Advantage Plan after starting hospice care, you can receive coverage for any issues unrelated to your terminal condition. 

Understand Your Medicare Hospice Benefits

Preparing for hospice is stressful, but understanding your Medicare hospice benefits can save you some of that stress. Start by determining your eligibility before diving into what coverage is available. Then, you can start delving into Medicare benefits.

Hospice plans are meant to cover what you need during the final few months of your life. However, there are some exceptions to coverage that are important to understand. Take control of your remaining time by preparing for the worst.

To get free Medicare help, contact us today and talk with one of our experienced agents. 

Scroll to Top