Hospice and Palliative Care: What They Are and How Medicare Pays

Families often first hear the words "hospice" and "palliative" in a stressful hospital hallway. Understanding them ahead of time makes for better decisions.

Palliative care: an extra layer of support

Palliative care can help anyone living with a serious illness, at any age or in any stage of disease — it is based on need, not life expectancy.^[1] It's delivered by an interdisciplinary team — specialist doctors and nurses plus social workers, nutritionists, and chaplains — in hospitals, outpatient clinics, nursing homes, or at home.^[2] Critically, in palliative care a person does not have to give up treatment that might cure their illness — it runs alongside curative care.^[2] It may also help people with serious illness stay out of the emergency room or hospital.^[1] Medicare, Medicaid, and many insurers cover the medical portions of palliative care, and veterans may be eligible through the VA.^[1]

Hospice: comfort-focused care near the end of life

Hospice care is a specific type of palliative care provided in the final weeks or months of life.^[2] The hospice philosophy affirms life but does not try to hasten or postpone death.^[3] In hospice, attempts to cure the terminal illness stop — but that doesn't mean all treatment stops; medicines that help comfort or unrelated conditions continue.^[2]

Although some hospice care is provided in hospitals, hospice facilities, or nursing homes, most patients are cared for in the place they call home.^[3] The hospice team — physician, nurses, home health aides, social workers, clergy or counselors, and trained volunteers — visits regularly, coaches family caregivers who provide the day-to-day care, and Medicare-certified hospices must have a 24/7 telephone line for crises.^[3][2]

Research consistently finds that families of people who received hospice care are more satisfied with end-of-life care, and hospice recipients are more likely to have their pain controlled and less likely to undergo tests or receive medicines they don't need.^[2] Many people begin hospice too late to get its full benefit — starting earlier can mean months of meaningful support.^[2]

The Medicare hospice benefit, in plain terms

Hospice is covered under Medicare Part A. To qualify:^[4]

1. The hospice doctor and your regular doctor certify a terminal illness with a life expectancy of 6 months or less.
2. You accept comfort care instead of care intended to cure the illness.
3. You sign an election statement choosing hospice.

Key facts families should know:^[4]

• The 6 months is not a cutoff. Coverage runs in two 90-day benefit periods followed by an unlimited number of 60-day periods, as long as the hospice doctor recertifies the terminal illness. Living longer than 6 months does not end the benefit.^[4][3]
• You can leave and come back. Patients can leave hospice (for example, to try a new treatment) and return later, and can change hospice providers once per benefit period.^[4][2]
• Costs are minimal. You pay nothing for hospice care itself from a Medicare-approved provider; up to a $5 copay per prescription for outpatient pain and symptom medications; and up to 5% of the approved amount for inpatient respite care.^[4]
• Respite is built in. Medicare covers up to 5 days of inpatient respite care at a time so the family caregiver can rest.^[3]
• Room and board are not covered — at home, in a nursing home, or in a hospice facility — though hospice-arranged short-term inpatient stays are.^[4]
• Bereavement support continues. Hospice programs offer grief support to the family for up to 13 months after a death.^[3]

Medicare still pays for treatment of health problems unrelated to the terminal illness, with normal deductibles and coinsurance.^[4]

Talking about it

These conversations are easier held early, when they're still hypothetical. The National Institute on Aging notes that starting hospice early can provide months of meaningful care and connection — the most common regret is waiting too long.^[2] CaringInfo (caringinfo.org), a program of the National Alliance for Care at Home, offers free state-specific advance directive forms and guidance for these decisions.^[3]