The Medicare Hospice Benefit: A Good Fit with Managed Care

by Naomi Naierman

Hospice is comprehensive care in the last months of life. Hospice services are provided by a coordinated team of doctors, nurses, social workers, grief counselors, spiritual counselors, physical therapists, home health aides and volunteers.

All services are provided at home, if at all possible. Otherwise, inpatient care is available in hospice facilities, special units in hospitals, and nursing homes.

Comprehensive Coverage with Minimum out of Pocket Expenses

As a Medicare beneficiary, you are entitled to the Medicare Hospice Benefit without additional premiums. If you are enrolled in a managed care organization (MCO) you have access to this benefit, even if the MCO does not cover hospice services.

The Medicare Hospice Benefit covers the following hospice services in full:

  • Skilled nursing services
  • Volunteer Services
  • Physician visits
  • Skilled therapy
  • Home health aide visits
  • Medical social services
  • Spiritual counseling
  • Nutrition counseling
  • Bereavement support for the family

The Medicare Hospice Benefit also covers 95% of the cost of the following although most hospices do not collect the 5% co-payment:

  • Drugs for pain and other symptoms
  • Inpatient respite care to relieve the caregiving responsibilities of the family

For services related to terminal illness, there are virtually no out-of-pocket expenses, even for drugs, equipment and other high cost items that are often needed in the last months of life. No other Medicare benefit offers such financial protection.

The Medicare Hospice Benefit does not cover 24-hour care, but during a medical crisis, continuous nursing and short-term inpatient services are available. The Medicare Hospice Benefit also does not cover personal services.

Maximum Choice

As a Medicare beneficiary, you can choose any Medicare-certified hospice in any area of the country. If you are in a managed care organization (MCO) you can select any hospice — you are not restricted to the MCO’s network of providers. You do not need a referral or approval, nor do you have to disenroll from the MCO. Should you need health services unrelated to the terminal illness, your MCO is obliged to provide these services as long as you do not disenroll.

If you prefer to be cared for by your own doctor, rather than the hospice physician, most hospices will accommodate you. Ask in advance if that is an option. Your doctor can be reimbursed by Medicare, even if he or she is not under contract with the hospice.

Reduced Family Burden

The family’s burden is reduced by the financial relief that the Medicare Hospice Benefit provides, and by volunteers that hospices offer in addition to the hospice staff. In every Medicare-certified hospice, there are volunteers that lend a helping hand to the family. They may do household chores, keep the patient company, and generally respond to the family’s need for support.

Bereavement services are available to the family for about a year after the death, so hospice patients can be reassured that support will continue well after they are gone.
After the hospice admission, there is virtually no paperwork, no bills, no claims, and no financial surprises.


To qualify for the Medicare Hospice Benefit:

  • You must have Medicare Part A
  • Your doctor and the hospice medical director must confirm that you have a life expectancy of less than six months
  • You must agree in writing not to pursue treatments for curing your illness

Some, though not all, hospices require that patients have a primary caregiver. Ask in advance if this is an additional admission criterion.

Having access to the hospice and Medicare Hospice Benefit means that comprehensive care at the end of life does not have to be expensive or burdensome to your family.

You should be able to die in comfort and with dignity in your own home, under the supervision of a coordinated team of hospice staff and volunteers. Family members, too, will be supported in their caregiving roles and in their grief.