Medicare Supplement Insurance Plans and Hospice Care
Medicare coverage for hospice care can lighten the burden for terminally ill Medicare beneficiaries and their loved ones. A Medicare Supplement insurance plan might lighten that burden even more.
Medicare Supplement insurance plans may cover out-of-pocket costs after Original Medicare, Part A and Part B, has paid its share of covered expenses, whether of hospice care or other medical expenses.
Hospice care includes a range of services (addressing physical, social, emotional, and spiritual, as well as certain medical needs) for terminally ill people. The focus is on patient comfort, not on efforts to cure the illness or prolong life. Usually a team of professionals provides care, often in the patient’s home. Hospice services also generally provide emotional and caregiving support to families.
Do Medicare Supplement insurance plans cover hospice care?
First, it’s important to understand that Medicare typically covers hospice care under Medicare Part A. However, you may be responsible for any Medicare-approved copayment or coinsurance associated with hospice (prescription drugs for pain relief, and respite care for caregivers, for example).
That’s where Medicare Supplement insurance comes in. Medicare Supplement (also called Medigap) insurance plans are offered by private insurance companies and may help you pay for out-of-pocket costs not paid under Original Medicare Part A (hospital insurance) and Part B (medical insurance). Medicare Supplement insurance plans fill the “gaps” in Original Medicare coverage. These “gaps” are the expenses you incur– such as deductibles, co-insurance and copayments–under Original Medicare.
Some other points to note about Medicare Supplement insurance plans:
- Medicare Supplement insurance plans have standardized benefits. In most states, there are up to 10 Medicare Supplement (Medigap) insurance plans available: Plans A through N (except for Plans E, H, I, and J, which are no longer sold). Each of these plans covers a certain percentage (between 0% and 100%) of Medicare out-of-pocket expenses, such as Medicare deductibles.
- If you buy a Medicare Supplement insurance Plan G in Ohio, for example, it would provide the same coverage as a Plan G in New Hampshire. However, the premiums for these plans may be different.
- Medicare Supplement insurance Plan A is not the same as Medicare Part A, despite the similar-sounding names. The same is true for Medicare Supplement insurance Plan B and Medicare Part B, as well as the other Medicare Supplement insurance plans and “parts” of Medicare.
- Three states have their own standardized Medicare Supplement insurance plans: Wisconsin, Minnesota, and Massachusetts.
The 10 standardized Medicare Supplement insurance plans available in most states do include hospice coverage—most cover 100% of any Medicare-approved copayment or coinsurance not paid under the Medicare Part A hospice benefit. Plan K cover 50% and Plan L covers 75% of the Medicare copayment or coinsurance amount.
For hospice care Medicare Part A (not Medicare Supplement insurance Plan A) pays:
- 100% for hospice care
- All but $5 for prescription drugs needed to provide comfort and control pain related to the terminal illness
- 95% for inpatient respite care
And your Medicare Supplement insurance plan pays
- A $2.50 to $5.00 copayment for prescription drugs (depending on plan availability and selection)
- A 2.5% to 5% for inpatient respite care (depending on plan availability and selection)
Who is eligible for Medicare hospice benefits?
You’re generally eligible for Medicare hospice benefits when you meet the following conditions:
- You have Medicare Part A (hospital insurance).
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the illness runs its normal course, death may be expected within six months or less.
- You sign a statement choosing hospice care instead of curative care for your illness.
- You receive care from a Medicare-approved hospice program.
What hospice care does Medicare Part A cover?
Medicare defines a set of core services that all hospices are required to provide to each person they serve. Medicare Part A may cover these hospice services when they’re needed during terminal illness and related condition(s) and ordered by your hospice care team:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Prescription drugs for symptom control or pain relief (you may need to pay a small copayment)
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (may need to pay a small copayment)
- Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team
What about respite care?
Sometimes your daily caregiver (such as a family member) may need a rest. In this situation your hospice team may arrange for you to receive inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home) on an occasional basis. You can stay in the facility up to 5 days each time you get respite care.
Some Medicare Supplement insurance plans cover the copayment or coinsurance for this respite care, when it’s approved by Medicare.
What does the Medicare Part A hospice benefit not cover?
Medicare generally won’t cover any of these once you choose hospice care:
- Treatment intended to cure your terminal illness
- Prescription drugs to cure your illness (rather than for symptom control or pain relief)
- Care from any hospice provider that wasn’t set up by the hospice medical team
All care that you get for your terminal illness must be given by or arranged by the hospice team. However, you may still be able to see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
- Room and board
Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility.
- Care in an emergency room, inpatient facility care, or ambulance transportation
unless it’s either arranged by your hospice team or is unrelated to your terminal illness.
What insurance coverage do you have if your circumstances change?
Sometimes a person’s health improves or the illness goes into remission. If that happens, the hospice physician may feel that you no longer need hospice care. In this case, you will be discharged from hospice, and you return to the care and the Medicare coverage you had before electing the hospice benefit. Furthermore, you always have the right to stop receiving hospice care at any time and for any reason. If you stop your hospice care, you will generally receive the type of Medicare coverage that you had before electing hospice, such as a Medicare Supplement insurance plan and Original Medicare Part A and Part B. If you are eligible, you can go back to hospice care at any time in the future.
Would you like more information about Medicare coverage and your options?
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