Does Medicare Cover Hospice Care?

When a family starts thinking about hospice, money is often the first worry. The good news is simple, and it takes a lot of pressure off: Medicare pays for almost all of it.

Short answer: Yes, Medicare covers hospice care. Medicare Part A pays for the hospice benefit when a person has a terminal illness with a prognosis of six months or less and chooses comfort care instead of treatment meant to cure. It covers nursing, doctor visits, medications for symptoms, equipment, counseling, chaplain support, and more. Most families pay little to nothing out of pocket.

Key takeaways

• Medicare Part A covers hospice. If you have Part A and meet the rules, your hospice care is covered.
• You pay almost nothing. Care is $0. You may pay up to $5 per prescription for symptom-relief drugs and 5% for short-term inpatient respite care.
• It covers the whole team. Nurses, doctors, aides, social workers, chaplains, therapists, and grief counselors are all included.
• There is no hard time limit. Coverage runs in benefit periods and continues as long as you stay eligible.
• Suncrest is Medicare-approved. Our hospice services are covered by Medicare.

Does Medicare Cover Hospice Care?

Yes. Medicare covers hospice care under Part A (hospital insurance) for people who qualify. According to Medicare.gov, you pay nothing for hospice care itself as long as you get it from a Medicare-approved hospice provider. The benefit is designed to cover comfort care for a terminal illness, so you and your family can focus on time together instead of bills.

Suncrest is a Medicare-certified hospice provider. That means the care we provide is covered by the Medicare hospice benefit, the same way it would be at any approved agency. You can learn more about our hospice care and how it works.

What Does Medicare’s Hospice Benefit Cover?

Medicare’s hospice benefit is broad. Once you elect hospice, it usually covers everything related to your terminal illness. Here is what is included, based on the official Medicare hospice benefits guide:

• Doctor services. Care and oversight from the hospice medical team, plus your own attending doctor if you choose to keep them.
• Nursing care. Regular visits from registered nurses to manage pain and symptoms, with a nurse on call 24 hours a day.
• Medications for symptom control. Drugs to manage pain, nausea, anxiety, and other symptoms tied to the terminal illness.
• Medical equipment. Items like a hospital bed, wheelchair, or oxygen, fully covered when needed for comfort.
• Medical supplies. Things like wound dressings and catheters.
• Hospice aide and homemaker services. Help with bathing, dressing, and light tasks like changing the bed.
• Therapy services. Physical, occupational, and speech therapy when they help with comfort and function.
• Social work services. Support with emotional concerns and help finding community resources.
• Dietary counseling. Guidance on eating and nutrition as needs change.
• Spiritual and chaplain support. Counseling that fits your beliefs and wishes.
• Grief and bereavement counseling. Support for the family, both before and after the death, for up to a year.
• Short-term inpatient care. A short stay in a facility if symptoms cannot be managed at home.
• Short-term respite care. A short inpatient stay that gives family caregivers a chance to rest.

The Four Levels of Hospice Care That Medicare Covers

Medicare pays for four levels of hospice care, and your team moves between them based on what you need. Routine home care is the most common. The others step in during a crisis or for short facility stays. You can read more in our guide on the The Four Levels of Hospice Care That Medicare Covers.

What Does Medicare NOT Cover Under Hospice?

The hospice benefit is generous, but it has limits. Once you elect hospice, Medicare does not cover the following:

• Treatment meant to cure your terminal illness. Hospice is comfort care, so curative treatment for the terminal condition is not covered.
• Prescription drugs for a cure. Medicines aimed at curing the terminal illness, rather than easing symptoms, are not covered under hospice.
• Room and board. Medicare does not pay for room and board at home, in a nursing home, in assisted living, or in a hospice residence.
• Care your hospice team did not arrange. Outside care for the terminal illness that the hospice did not set up is not covered.
• Emergency or ambulance care not arranged by hospice. ER visits, hospital stays, or ambulance trips for the terminal illness are only covered if your hospice team arranges them.

One important point: if you have a health problem that is not related to your terminal illness, regular Medicare still covers it as usual. You do not lose your other coverage by choosing hospice.

What Will Hospice Cost Me?

For most families, the cost of hospice is very low. Here is what Medicare.gov says you may pay:

• $0 for hospice care from a Medicare-approved provider.
• Up to $5 per prescription for outpatient drugs that manage pain and symptoms.
• 5% of the Medicare-approved amount for inpatient respite care, and that copay can never be more than the year’s inpatient hospital deductible.

The main cost the benefit does not cover is room and board if your loved one lives in a facility. That is billed separately. If you want to understand the respite piece in more detail, see our explainer on does Medicare cover respite care.

Who Qualifies for the Medicare Hospice Benefit?

To get the Medicare hospice benefit, a person needs to meet a few clear rules:

• They have Medicare Part A.
• A hospice doctor and their own doctor certify a terminal illness, with a life expectancy of six months or less if the illness runs its normal course. This is often called the six-month rule.
• They sign a statement choosing hospice (comfort) care instead of treatment meant to cure the terminal illness.

The six-month rule does not mean a person must die within six months. It is a prognosis, not a deadline. Many people live longer and stay on hospice as long as they remain eligible. For a deeper look at the rules, see our guide on who qualifies for hospice care at home under Medicare.

How Long Does Medicare Pay for Hospice?

There is no hard limit on how long Medicare pays for hospice, as long as the person stays eligible. Coverage is set up in benefit periods. The Centers for Medicare & Medicaid Services (CMS) explains it this way:

• Two 90-day periods to start.
• An unlimited number of 60-day periods after that.

At the start of each period, a hospice doctor has to recertify that the person is still terminally ill. Before the third benefit period, and before every period after that, a hospice doctor or nurse practitioner must also have a face-to-face visit with the patient to confirm they still qualify. This is a routine part of the process, and your team handles it.

You can also leave hospice at any time. If you want to try curative treatment again, you can revoke the benefit and return to regular Medicare, then re-elect hospice later if you choose. For more detail, read how long Medicare pays for hospice care and How many days of hospice does Medicare pay for?

Does Medicaid Cover Hospice?

Yes. Nearly every state Medicaid program covers hospice care, and most build their benefit on the Medicare model. Like Medicare, Medicaid hospice care is typically fully covered, with little or no cost to the patient and family. The rules and eligibility can vary by state, so it is worth confirming the details locally.

There is one helpful difference. Medicare does not pay for room and board in a facility, but in many states Medicaid does cover room and board when a hospice patient lives in a nursing facility. If your loved one has both Medicare and Medicaid, this can fill a real gap. Your hospice team can help you sort out how the two work together.

Does Medicare Advantage Cover Hospice?

Yes. If you have a Medicare Advantage plan, hospice is still covered. Your hospice benefit is paid through Original Medicare, even while you stay enrolled in your Advantage plan. You keep your plan and continue paying its premium, and your hospice care is covered the same way it would be for anyone on Original Medicare.

Suncrest Accepts Medicare

Suncrest is a Medicare-approved hospice provider, so our services are covered by the Medicare hospice benefit. Cost should never be the reason a family waits to ask about hospice. If you are not sure whether you qualify or what your plan covers, we will walk you through it at no charge.

We serve communities across the country. You can find a Suncrest location near you and reach out with any questions. If you are also wondering how to talk with your loved one during this time, our guide on what to say and what not to say to someone in hospice may help.

Frequently Asked Questions

Does Medicare cover hospice care?

Yes. Medicare Part A covers hospice care for people who have a terminal illness with a prognosis of six months or less and who choose comfort care over treatment meant to cure. You pay nothing for the care itself from a Medicare-approved provider. The benefit covers nursing, doctor visits, symptom medications, equipment, counseling, chaplain support, aide services, and more.

What is the Medicare hospice benefit?

The Medicare hospice benefit is a Part A program that pays for comfort-focused care for a terminal illness. It covers a full care team, medications for symptom relief, medical equipment and supplies, therapy, social work, spiritual care, and grief support for the family. Care is delivered by a Medicare-certified hospice, most often in the patient’s home.

How long does Medicare pay for hospice?

There is no fixed limit. Medicare covers hospice in two 90-day benefit periods, followed by an unlimited number of 60-day periods. A hospice doctor recertifies eligibility at the start of each period, and a face-to-face visit is required before the third period and each one after. Coverage continues as long as the person stays eligible.

What does Medicare not cover under hospice?

Medicare hospice does not cover treatment meant to cure the terminal illness, prescription drugs aimed at a cure, or room and board in a home or facility. It also does not cover care, emergency visits, or ambulance trips for the terminal illness that the hospice team did not arrange. Health problems unrelated to the terminal illness are still covered by regular Medicare.

How much does hospice cost with Medicare?

Most families pay little to nothing. Hospice care is $0 from a Medicare-approved provider. You may pay up to $5 per prescription for outpatient symptom-relief drugs and 5% of the Medicare-approved amount for inpatient respite care, capped at the year’s inpatient hospital deductible. Room and board in a facility is billed separately and is not covered.

Does Medicaid cover hospice?

Yes. Almost all state Medicaid programs cover hospice, usually modeled on the Medicare benefit and fully covered for the patient. Unlike Medicare, many states also cover room and board through Medicaid when a hospice patient lives in a nursing facility. Rules vary by state, so confirm the details locally or ask your hospice team.

What are the eligibility rules for Medicare hospice?

To qualify, a person must have Medicare Part A, be certified by a hospice doctor and their own doctor as having a terminal illness with a life expectancy of six months or less if the illness runs its normal course, and sign a statement choosing comfort care over curative treatment for that illness. The six-month rule is a prognosis, not a deadline.

Call Suncrest Today

Cost should not keep you from exploring hospice. Medicare covers nearly all of it, and Suncrest is a Medicare-approved provider, so our services are covered. If you have questions about coverage, eligibility, or what comes next, our team is here to help, day or night.