How Long Will Medicare Pay For Hospice Care?

Hospice care provides much-needed comfort and dignity to those facing the final stages of life, offering physical, emotional, and spiritual support. For families, it is often a relief to know that Medicare can cover many of these essential services, helping to ease the financial strain during an already difficult time. 

But a common question often comes up: how long will Medicare pay for hospice care?

This can be a big worry for caregivers and families who are already under immense stress. The thought of Medicare support running out can add more pressure when all you want is to make sure your loved one gets the care they need. 

Don't worry, this article will explain how long Medicare will cover hospice care, what it pays for, and what happens if you need care for a longer time. 

What Are Medicare’s Rules for Hospice Coverage?

Medicare provides extensive coverage for hospice care, but there are specific rules and requirements to qualify. These rules are designed to ensure hospice care is reserved for those who truly need it while helping families go through the process with ease. 

Here are the main requirements for hospice coverage under Medicare:

• The patient must be enrolled in Medicare Part A, which is the hospital insurance part of Medicare that includes hospice care coverage. Without Part A, hospice care cannot be covered.
• A doctor, along with the hospice team, must certify that the patient has a terminal illness with a life expectancy of six months or less if the illness follows its normal course. This certification is required to begin hospice care.
• The patient must choose palliative care, focusing on comfort and symptom management, instead of treatment aimed at curing the illness. This means they are opting to prioritize quality of life over aggressive medical treatments.
• The patient or their representative must sign a document formally choosing hospice care instead of standard Medicare-covered treatments for their terminal illness.

How Long Can a Patient Stay in Hospice?

Medicare allows patients to stay in hospice for as long as they qualify, with coverage divided into specific benefit periods. 

The initial structure includes two 90-day periods. After these, patients can continue receiving hospice care through an unlimited number of 60-day renewal periods, as long as they still meet Medicare’s eligibility criteria.

Eligibility is maintained through regular doctor recertifications, which confirm that the patient’s condition remains terminal with a life expectancy of six months or less. This process ensures patients receive ongoing care without interruptions. 

What is the Average Length of Stay in Hospice?

In 2021, the average length of stay for Medicare patients in hospice was 92 days, or roughly three months. However, the median length of stay was much shorter, which is only 17 days, or less than three weeks. 

At What Stage Do You Go Into Hospice?

A patient is ready for hospice care when their doctor determines they have a terminal illness with a life expectancy of six months or less if the illness runs its normal course. This is based on medical evaluations and the patient’s overall health. 

Medicare requires certification from both the patient’s primary doctor (if they have one) and a hospice doctor to confirm the prognosis.

Emotional readiness is also a factor. Hospice focuses on comfort care rather than curative treatments, so patients and families must decide to prioritize quality of life over further attempts to cure the illness.

What is Usually Not Included in Hospice Care?

Medicare hospice benefits exclude some treatments and services, including:

• Treatments intended to cure the terminal illness.
• Prescription drugs not related to the terminal illness, though these may be covered by Medicare Part D.
• Room and board unless it is part of short-term inpatient or respite care arranged by the hospice team.
• Services from providers not approved or coordinated by the hospice team.

Is Hospice Free?

Medicare covers most hospice-related costs, including nursing care, medications for symptom management, and medical supplies like bandages or wheelchairs. These services are fully paid for, with no deductible required.

There are some out-of-pocket costs:

• Up to $5 for prescription drugs used for pain and symptom control.
• 5% of the Medicare-approved amount for respite care, which is temporary inpatient care to give family caregivers a break.
• Your monthly premiums for Medicare Part A and Part B.

These costs are generally low, making hospice care accessible for most families.

What Happens If Hospice Coverage Ends?

Medicare hospice coverage may end in a few situations. If the patient’s health improves or their illness goes into remission, they may no longer meet the criteria for hospice care. In these cases, a doctor must certify that the patient no longer has a terminal prognosis of six months or less. Patients can also choose to stop hospice care at any time if they decide to pursue curative treatments or other types of care.

If hospice care ends, it can be restarted later if the patient becomes eligible again. Medicare allows patients to re-enroll in hospice as many times as necessary, as long as a doctor recertifies the terminal illness. Patients who leave hospice care will still have access to regular Medicare coverage, including hospital and medical services under Original Medicare or a Medicare Advantage Plan.

Conclusion

Medicare provides long-term hospice care support as long as the patient meets the eligibility rules. There is no strict time limit on how long will Medicare pay for hospice care, as benefit periods include unlimited 60-day renewals with proper recertification. This means patients can continue receiving care for as long as their doctor confirms they qualify.

This flexible system ensures families can focus on keeping their loved ones comfortable without worrying about losing coverage. If hospice care ends for any reason, it can start again if the patient’s condition changes. Medicare’s approach provides ongoing access to hospice care, giving families much-needed peace of mind during this difficult time.



If you’re unsure if hospice care is the right choice, contact Valley Oaks Hospice today. We can answer your questions, guide you through your options, and help you create a care plan that brings comfort and peace to your loved one when they need it most.