How Hospice Works
- Nurses or nurse practitioners
- Social workers
- Physical and occupational therapists
- Speech-language pathologists
- Hospice aides
A hospice doctor is part of your medical team. You can also choose to include your regular doctor or a nurse practitioner on your medical team as the attending medical professional who supervises your care.
In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week, to give you and your family support and care when you need it.
Only your hospice doctor and your regular doctor or nurse practitioner (if you have one) can certify that you’re terminally ill and have 6 months or less to live.
If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care.
Where you get hospice care
The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If your hospice team determines that you need inpatient care, they’ll make the arrangements for your stay.
How long you can get hospice care
Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.
- You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
- You have the right to change your hospice provider once during each benefit period.
- At the start of the first 90-day benefit period, your hospice doctor and your regular doctor or nurse practitioner (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less). At the start of each benefit period after the first 90-day period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care.
Finding a hospice program
Consider these questions when choosing your hospice care providers:
- Is the hospice provider certified and licensed by the state or federal government?
- Does the hospice provider train caregivers to care for you at home?
- How will your doctor work with the doctor from the hospice provider?
- How many other patients are assigned to each member of the hospice care staff?
- Will the hospice staff meet regularly with you and your family to discuss care?
- How does the hospice staff respond to after-hour emergencies?
- What measures are in place to ensure hospice care quality?
- What services do hospice volunteers offer? Are they trained?
The hospice provider you choose must be Medicare-approved to get Medicare payment. To find out if a certain hospice provider is Medicare-approved, ask your doctor, the hospice provider, your state hospice organization, or your state health department.
If you’re in a Medicare Advantage Plan (like an HMO or PPO) and want to start hospice care, ask your plan to help find a hospice provider in your area. Your plan must help you locate a Medicare-approved hospice provider in your area.
If you’re in a Medicare Advantage Plan or other Medicare health plan
Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan. If you were in a Medicare Advantage Plan before starting hospice care, you can stay in that plan, as long as you pay your plan’s premiums.
If you stay in your Medicare Advantage Plan, you can choose to get services not related to your terminal illness from either providers in your plan’s network or other Medicare providers.
If you choose to leave hospice care, your Medicare Advantage Plan won’t start again until the first of the following month.
Care for your other conditions
Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness. Your hospice benefit will cover these services even if you remain in a Medicare Advantage Plan or other Medicare health plan.
After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren’t part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren’t part of your terminal illness and related conditions.
Important: If you were in a Medicare Advantage Plan before starting hospice care, and you decide to stay in that plan:
- You can get covered services for any health problems that aren’t part of your terminal illness and related conditions.
- You can choose to get services not related to your terminal illness from either your plan or Original Medicare.
- What you pay will depend on the plan and whether you follow the plan’s rules like seeing in-network providers. If your plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services as long as you continue to pay your plan’s premiums and other costs.
Stopping hospice care
If your health improves or your illness goes into remission, you may no longer need hospice care.
You always have the right to stop hospice care at any time. If you choose to stop hospice care, you’ll be asked to sign a form that includes the date your care will end.
You shouldn’t be asked to sign any forms about stopping your hospice care at the time you start hospice. Stopping hospice care is a choice only you can make, and you shouldn’t sign or date any forms until the actual date that you want your hospice care to stop.
If you were in a Medicare Advantage Plan when you started hospice, you can stay in that plan by continuing to pay your plan’s premiums. If you stop your hospice care, you’re still a member of your plan and can get Medicare coverage from your plan after you stop hospice care. If you weren’t in a Medicare Advantage Plan when you started hospice care, and you decide to stop hospice care, you can continue in Original Medicare.
If you’re eligible, you can go back to hospice care at any time.