Does Medicare Cover Hospice Care?

Yes. Medicare provides comprehensive hospice coverage through the Medicare Hospice Benefit — and it's one of the most valuable and least-understood benefits in all of Medicare. If you or a loved one in San Diego is facing a terminal illness, understanding this benefit can significantly reduce financial stress and help ensure access to compassionate end-of-life care.

What Is the Medicare Hospice Benefit?

The Medicare Hospice Benefit is a specialized care option for people with a terminal illness whose doctor certifies they have six months or less to live if the illness runs its expected course. Hospice shifts the focus from curative treatment to comfort, quality of life, and support for both the patient and their family.

Under this benefit, Medicare covers virtually everything related to the terminal diagnosis — usually with very little to no out-of-pocket cost.

What Does Medicare Hospice Cover?

The Medicare Hospice Benefit covers a comprehensive set of services, including:

• Physician and nursing services — hospice nurse and doctor visits at home or in a facility
• Medications — all drugs related to the terminal illness and pain management (no separate Part D costs for these)
• Medical equipment — hospital beds, wheelchairs, oxygen, and other durable medical equipment needed for comfort
• Aide services — help with bathing, dressing, and personal care
• Social worker services — emotional and practical support for the patient and family
• Spiritual care — chaplain services, if desired
• Bereavement counseling — support for family members after the patient passes, covered for up to a year
• Short-term inpatient respite care — temporary inpatient care to give family caregivers a break

What Does Medicare Hospice Cost?

For most hospice services, you pay:

• $0 for hospice care itself
• Up to $5 per prescription for pain and symptom management drugs
• 5% of the Medicare-approved amount for inpatient respite care (typically a few days at a time)

Room and board in a nursing facility or hospice facility is generally not covered by Medicare — but if you're receiving hospice at home or in an assisted living community you already pay for, the hospice services themselves are fully covered.

How Do You Qualify for Medicare Hospice?

To qualify for the Medicare Hospice Benefit:

1. You must be enrolled in Medicare Part A
2. Your doctor and the hospice medical director must certify that you have a terminal illness with a life expectancy of 6 months or less if the illness runs its natural course
3. You must choose to receive comfort care rather than curative treatment for the terminal illness
4. You must receive care from a Medicare-approved hospice provider

Importantly, choosing hospice does not mean giving up all medical care. Medicare continues to cover treatments and services for conditions that are unrelated to the terminal illness. You can also leave hospice care and return to curative treatment at any time if your condition changes or your wishes change.

How Long Does Medicare Cover Hospice?

Medicare hospice coverage is provided in benefit periods:

• Two initial 90-day periods
• Followed by unlimited 60-day periods

At the start of each period, a hospice doctor must re-certify that the patient still meets the eligibility criteria. If a patient lives longer than expected, they can continue to receive Medicare hospice coverage as long as they continue to meet the criteria. There is no limit to the total number of days of hospice care Medicare will cover.

Does Hospice Work the Same on Medicare Advantage?

This is an important distinction. If you're enrolled in a Medicare Advantage plan, hospice care is actually paid for by Original Medicare, not your Advantage plan. Your Medicare Advantage plan continues to cover other, unrelated medical care during the hospice period. The hospice benefit itself works the same regardless of whether you're on Original Medicare or Medicare Advantage.

Finding Hospice Providers in San Diego County

San Diego County has numerous Medicare-approved hospice providers, including both nonprofit and for-profit agencies. If you're not sure where to start, a physician referral or a call to a Medicare broker can help point you in the right direction. Ashley Watson can help answer questions about how your specific Medicare plan coordinates with hospice care.

Have Questions About Your Medicare Coverage?

If you or a family member has questions about the Medicare Hospice Benefit, your current plan's coverage, or any aspect of Medicare in San Diego County, Ashley Watson is here to help — for free. Schedule a free consultation or call (619) 947-2325, seven days a week.