Medicare Covered and Non-Covered Services

  • Medicare defines a set of core services that hospices are required to provide to every person they serve, regardless of the person’s insurance.
  • Under the Medicare Hospice Benefit, your loved one will have to pay only a part of the cost of outpatient drugs and inpatient respite care.
  • Treatment and medications intended to cure an illness are generally not covered under the Medicare Hospice Benefit, but you should check with the hospice and your loved one’s physician.

Next Step

Learn the most important factors to consider when selecting a hospice.

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Covered Services

Most of the services, medicine, equipment and supplies used to make your loved one more comfortable are covered by the Medicare Hospice Benefit. Hospice team members should be able to inform you which of your loved one’s medications are covered and which are not. In general, Medicare covers the following hospice services and pays for nearly all of their costs:

  • Doctor services
  • Nursing care
  • Medical equipment (such as wheelchairs or walkers)
  • Medical supplies (such as bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term hospital care, including respite and inpatient care for pain and symptom management
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social work services
  • Dietary counseling
  • Grief support to help you and your family

Non-Covered Services

The following items are not covered as part of the Medicare Hospice Benefit:

  • Medications not directly related to your loved one’s hospice diagnosis are not covered under the Medicare Hospice Benefit, though they may continue to be covered by your loved one’s existing Medicare coverage.
  • Your loved one always has the right to stop getting hospice care and revert to previous Medicare coverage she or he had before electing hospice.
  • Care from another provider that duplicates care from your loved one’s hospice. All care for the illness must be given by your hospice team. You can’t get the same type of care from a different provider unless you change your hospice provider.
  • Nursing home room and board. Your loved one may receive hospice services wherever she lives, but the Medicare Hospice Benefit does not pay for nursing home room and board.

Next Step: Learn about the key factors to consider when choosing a hospice.

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Additional Resources

 

Content shown was developed through a collaboration between AGIS and the National Hospice and Palliative Care Organization.