How does Medicare cover hospice and respite care?
Dear Toni: As a certified case manager and critical care unit registered nurse, I advise people who are seeking help for a parent or spouse with end-of-life issues. Those who have serious health care issues should be offered every option for proper planning with end-of-life care, especially hospice.
Can you explain hospice and respite care to your readers? I am sure this will help those who are seeking assistance for their loved ones while allowing the caregiver well-needed rest. — Deidre, Tulsa, Okla.
Dear Deidre: Hospice is a subject that probably no one wants to discuss with an elderly loved one. Caring for someone with a terminal illness takes an emotional toll on the caregiver and the family as well as on the patient.
Many people wait too long to discuss hospice benefits with the patient’s doctor because they think hospice is only for the last days of life. They are not aware that hospice can give hope along this journey with education, medication to manage symptoms, support for the patient and family, and counseling services.
Health care professionals in the hospice system include physicians, nurses, social workers, spiritual counselors, certified nursing assistants and volunteers. A hospice provider comes to where the patient lives to provide the care.
The 2026 “Medicare & You” handbook explains what hospice is in Medicare terms and what Medicare covers under Part A. A doctor who orders hospice must certify that a patient is terminally ill and has six months or less to live. When patients agree to hospice care, they agree to comfort care (palliative) instead of treatment to cure the illness and must sign a statement choosing hospice care instead of other Medicare-covered treatments.
Hospice can be recertified every six months by a hospice medical director or hospice doctor if the patient continues to meet qualifications for terminal illness. Original Medicare will be billed for the care.
Hospice will cover all medical care for terminal illness, and original Medicare or a Medicare Advantage Plan will pay for health problems that are not related to the terminal illness (copays will apply). Medicare-certified hospice care is usually administered in the home or other facility, such as a nursing home or personal care home.
Here are some Medicare costs associated with hospice benefits:
■ Nothing for hospice care (Medicare pays).
■ Copayment of up to $5 per prescription for outpatient drugs for pain and symptom management.
■ Five percent of the Medicare-approved amount for inpatient respite care for the beneficiary.
■ Caregiver relief and support: You pay nothing for Medicare-approved inpatient respite care, which gives your caregiver a rest period of up to five days.
Talk with a geriatric case manager or geriatric doctor if you have concerns or need advice about a loved one’s terminal health care issue.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
