Part A - Hospice Care

If a patient is willing to waive coverage under Medicare Part A and certain other criteria are met, Medicare will cover many aspects of palliative hospice care.

How Is Eligibility Determined?

A physician must use his or her best clinical judgment in diagnosing the patient with a terminal illness to trigger eligibility for hospice care. In addition, death must be expected, though it need not actually occur, within six months.

Also, a waiver of Part A coverage must be executed by the patient or his or her representative. The waiver states that the patient is waiving Part A coverage and that the patient understands that the care he or she is receiving is palliative in nature, not curative.

What Coverage Is Available?

In many ways, Medicare hospice coverage is broader than its Part A counterpart. Hospice benefits will pay for palliative physician and nursing care, including pain control, symptom management, and respite care for the patient's caretakers. Hospice benefits also cover short-term inpatient care, medical supplies, various types of therapy, home health aides, homemaker services, social worker services, and family counseling.

The care must be provided in a Medicare-certified hospice unit or by a provider under a contract to provide hospice services, although respite care provided by an intermediate care provider is also covered.

Coverage is for two sequential 90-day periods, but due to the unpredictable nature of terminal illnesses, extensions are available. The first is for 30 days, and the second is of indefinite duration.

Hospice patients are responsible for minimal co-payments for prescriptions and for respite care.

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