FAQ: What is the Medicare Hospice Benefit?

Currently, most hospice patients are eligible for the Medicare Hospice Benefit.
With the Medicare Hospice Benefit, there are usually no bills and no out-of-pocket costs for the patient and the family. The hospices are only permitted to charge small amounts for medications (no more than $5 per prescription) and inpatient hospital stays (up to 5% of the Medicare approved amount). Hospices often choose to not bill patients for these charges.

Eligibility for Medicare

  • To qualify for Medicare (Part A – Hospital Insurance), a person must:
  • Be 65 and over, or
  • Be totally disabled for at least two years, or
  • Have end-stage renal disease (complete kidney failure).

Eligibility for Medicare Hospice Benefit

  • To be eligible for Medicare Hospice Benefit, a person must:
  • Be enrolled in the Medicare Part A (see above), and
  • Have a doctor and the hospice medical director certify that they are terminally ill and probably have less than six months to live, and
  • Sign a statement choosing hospice care instead of routine Medicare covered benefits for their terminal illness, and
  • Receive care from a Medicare-approved hospice program.

Things to keep in mind when signing up for Medicare Hospice Benefits

  • Once a person signs up for the Medicare Hospice Benefit:
  • Medicare will continue to pay for covered benefits for any health problems that are NOT related to the terminal illness.
  • Medicare will not pay for treatments and medications to cure the terminal illness.
  • Medicare will not pay for medical care or services that are not arranged by the hospice.

Individuals who sign up for the Medicare Hospice Benefit always have the right to stop hospice care at any time and get the Medicare coverage they had before they chose to receive hospice care.