Plain-language guide
The Medicare hospice benefit, explained
If your loved one has Medicare Part A and qualifies for hospice, Medicare covers nearly all of the cost of hospice care. Here's what that means.
The short version
- For hospice care itself
- $0
- Copay per prescription for symptom and pain drugs
- Up to $5
- Of the Medicare-approved amount for inpatient respite care
- 5%
- Prognosis a physician certifies to begin
- 6 months
Source: Medicare.gov, "Hospice care" coverage. Room and board at home or in a nursing home is not covered by the hospice benefit.
What Medicare covers in hospice
- Doctor and nursing services
- Hospice aide and homemaker services
- Medical equipment such as hospital beds and wheelchairs
- Medical supplies such as bandages and catheters
- Medications for pain and symptom control
- Physical, occupational and speech therapy when needed
- Social work and dietary counseling
- Grief and loss counseling for patient and family
- Short-term inpatient care for pain and symptoms
- Short-term inpatient respite care for caregivers
The four levels of hospice care
| Level | What it is | Where at Serenity |
|---|---|---|
| Routine home care | Regular visits from the hospice team wherever the patient lives | Homes, assisted living and nursing facilities in all 21 NJ counties |
| Continuous home care | Nursing care at home for short periods of crisis to keep the patient comfortable | [Confirm continuous care availability] |
| General inpatient care | Short-term hospital-level care for pain or symptoms that can't be managed at home | Serenity Hospice Inpatient Unit at RWJUH Hamilton |
| Inpatient respite care | Up to 5 days of inpatient care so family caregivers can rest | [Confirm respite locations] |
Eligibility and benefit periods
Physician certification
Your doctor and the hospice medical director certify a life expectancy of six months or less if the illness runs its normal course.
Choose comfort care
The patient chooses comfort care instead of treatment meant to cure the terminal illness, and signs a hospice election statement.
Benefit periods
Two 90-day periods, then an unlimited number of 60-day periods, with recertification each time.
Change your mind any time
Patients can stop hospice at any time and return to regular Medicare coverage.
Coverage questions
Does Medicare pay 100% for hospice?
For most patients, yes. Medicare pays for hospice care with no deductible. You may pay up to $5 per prescription for pain and symptom drugs and 5% of the Medicare-approved amount for inpatient respite care. Room and board is not covered by the hospice benefit.
Does Medicaid cover hospice in New Jersey?
Yes, NJ Medicaid covers hospice for eligible patients, and can also help with nursing home room and board. [Confirm Serenity's accepted Medicaid managed care plans]
Can someone keep seeing their own doctor on hospice?
Yes. Patients can keep their regular doctor as the attending physician, who works with the hospice team.
Can a patient leave hospice?
Yes. Patients can stop hospice care at any time, and can return later if they still qualify.