Seniors enrolled in Medicare Advantage plans are covered for hospice care through Original Medicare, as long as the hospice provider is Medicare-approved. The costs of hospice are covered by Original Medicare, and seniors can decide to opt out of their Medicare Advantage plan once the hospice benefit begins.
What Type of Hospice Care is Covered By Medicare?
Hospice care helps terminally ill people live more comfortably. Once a senior chooses this path, a team of health care professionals works with the family to create a plan that addresses their physical, emotional, social and spiritual needs. The hospice team may include doctors, nurses, social workers, pharmacists, physical therapists, occupational therapists, counselors and aides.Care takes place in a hospice inpatient facility or at home, so the family can remain together. Expenses, such as physical care, counseling, medication, equipment and supplies, are covered by Original Medicare (Part A).
How Does Coverage for Hospice Care Work?
To be eligible for coverage, seniors must be certified as terminally ill by their doctor and choose a hospice provider that is Medicare-approved. The Medicare Advantage plan must help members find an approved hospice provider if required.
Choosing Between Original Medicare and Medicare Advantage
Seniors receiving a hospice care benefit can choose to leave their Medicare Advantage plan once hospice care begins, but they must pay Original Medicare (Part A and B) premiums.
Those who remain in their Medicare Advantage plan pay premiums to their insurer and receive all additional benefits provided by the plan, such as vision or dental care. Original Medicare still covers hospice care if a senior remains in a Medicare Advantage Plan.
What Costs Are Covered?
Original Medicare covers all costs related to the terminal illness and related conditions, including doctors’ fees, nursing care, wheelchairs, catheters, physical therapy and grief counseling. There are no deductibles. In some cases, there may be a small co-payment for medication to help manage pain or for inpatient respite care if the family needs a rest.
Medicare also covers inpatient care at a hospital if the hospice provider deems it necessary. The hospital stay must be arranged by the hospice provider, and the cost is reimbursed to the hospice provider.
Health Care Costs Unrelated to the Terminal Illness
Original Medicare also pays for care for health conditions unrelated to the terminal illness, such as a broken arm. Deductibles and coinsurance amounts still apply. Those who remain enrolled in a Medicare Advantage plan after the hospice benefit starts can choose to receive coverage for unrelated health conditions from Original Medicare or their Medicare Advantage plan.
Benefit Periods for Hospice Care
Hospice benefits are provided for two 90-day benefit periods, followed by unlimited 60-day benefit periods. The hospice doctor must certify that a senior is terminally ill at the start of each benefit period for coverage to continue.
Seniors can choose to stop hospice care if their health improves or they decide they no longer want the care. They may return to their Medicare Advantage plan by continuing to pay premiums and they can reenter hospice care at any time, if needed.
