Got Questions About Medicare Hospice Services? Here Are Some Answers

Learning about services that Medicare covers, and their cost, is an important discussion topic for Medicare beneficiaries. However, there is one subject that rarely comes up: hospice, end-of-life care for the terminally ill.

Many studies have shown that earlier end-of-life care can have a positive impact: reduced administration of unnecessary medications, fewer hospital admissions and less depression in survivors. As a homecare nurse, I witnessed the value of hospice care. Yet, in too many cases, it was a last-minute decision and neither the patient nor the family reaped the full benefit.

Perhaps a brief Q&A can plant the seed so those who may face an end-of-life situation in the future will know that hospice can help.

What is hospice?

Hospice is a holistic approach to care, focusing on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.

How long has hospice been around?

The idea of a specialized program for the dying began in England. It was first discussed in the U.S. in the early 1960s. In 1985, hospice became a permanent Medicare program.

What is the patient’s situation?

The patient must give up curative treatments and accept palliative care, focusing on pain relief and symptoms management. (This may be a reason that hospice services are often delayed.) A hospice physician and the patient’s primary physician, if available, must certify that the individual is terminally ill, with a medical prognosis of six months or less. If the patient lives longer than that and still meets the qualifications, there can be recertification.

How does hospice work?

An interdisciplinary team, made up of a hospice doctor or medical director, nurses, social workers, counselors, dieticians, home health aides, clergy and volunteers, works with the patient and family. There are different levels of care, from routine and continuous home care to general inpatient care. The goal is to make sure that a person’s last days may be spent with dignity and quality.

What is the cost-sharing when Medicare covers hospice services?

Part A, hospital insurance, covers hospice care. A Medicare-certified hospice must provide the services. There is no deductible and the only cost is a 5% coinsurance for inpatient respite stays and hospice-related medications.

Where can a patient receive hospice care?

Patients can receive this care in their homes, an assisted-living facility, a nursing home, hospital or hospice facility. The Medicare hospice benefit does not cover room and board.

How can you find a Medicare-certified hospice?

Go to the “Find & compare providers near you” website and click on “Hospice care” in the left sidebar.

What is the benefit for the patient’s caregivers?

There are many benefits. The interdisciplinary team provides support, expertise and help with planning. Caregivers can get a break through the services of volunteers or brief respite stays. And, after death, there are bereavement services (grief support) for several months.

What if the patient has a medical issue not related to the terminal diagnosis?

For instance, a patient with lung cancer sprains his ankle. Part B, medical insurance, would cover the x-ray and physical therapy, and Part D, prescription drug coverage, would help pay for the pain medication.

How does hospice work for those who elected Medicare Advantage?

Medicare Advantage plans cannot provide hospice services. This probably goes back about 40 years when both Medicare hospice services and Medicare Advantage plans were getting started. There wasn’t enough data to evaluate the impact that each would have on the other. Terminally ill beneficiaries who elect this coverage will receive hospice care under Part A through a Medicare-certified hospice. The Medicare Advantage plan will continue to cover the patient’s issues, like a sprained ankle, not related to the terminal condition.

For a short time, it appeared things might change. In 2021, the Centers for Medicare and Medicaid Innovation started a three-year program to test the inclusion of hospice services in Medicare Advantage plans. In the first year, 53 plans participated. In March 2023, CMS decided to extend the model five more years, through 2030. Then, just one year later, in March 2024, CMS announced that it was ending the program as of December 31, 2024.

CMS cited operational challenges and decreasing participation. Hospice care delivery and payment work differently from the Medicare Advantage model. This year, there are 78 plan benefit packages, down from 119 in 2023.

There’s Much More to Learn

Hospice is not something people want to think or talk about but it’s something many of us will need. This post is just a basic introduction and you can learn more from these websites.

• National resources: National Hospice and Palliative Care Organization (NHPCO} and National Association for Home Care and Hospice.

• Local resources: Area Agency on Aging and State Hospice Association, and

• Medicare hospice services on the CMS website.

Then, one day, if you find yourself in a situation, you’ll have an important head start on determining your own fate.