Hospice Coverage

Hospice is a comprehensive, holistic program of care and support for terminally ill patients and their families. Hospice care changes the focus to comfort care (palliative care) for pain relief and symptom management instead of care to cure the patient’s illness.

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Patients with Medicare Part A can get hospice care benefits if they meet the following criteria:​

• They get care from a Medicare-certified hospice

• Their attending physician (if they have one) and the hospice physician certifies them as terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course

• They sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions

 

After certification, the patient may elect the hospice benefit for:

 

• Two 90-day periods followed by an unlimited number of subsequent 60-day periods.

• After the second, 90-day period, the recertification associated with a hospice patient’s third benefit period, and every subsequent recertification, must include documentation that a hospice physician or a hospice nurse practitioner had a face-to-face (FTF) encounter with the patient. The FTF encounter must document the clinical findings supporting a life expectancy of 6 months or less.

 

All hospice care and services offered to patients and their families must follow an individualized written plan of care (POC) that meets the patient’s needs. The hospice interdisciplinary group establishes the POC together with the attending physician (if any), the patient or representative, and the primary caregiver. (Centers for Medicare & Medicaid Services)

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Learn more about the hospice eligibility criteria set by Centers for Medicare & Medicaid Services.

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