What Medicare Does and Does Not Cover in Hospice Care

The Medicare Hospice Benefit, covered under Medicare Part A, pays for a comprehensive set of hospice services for eligible patients, including nursing visits, medications related to the terminal diagnosis, medical equipment and supplies, aide services, social work, spiritual care, and bereavement support. 

Medicare does not cover curative treatment for the terminal illness once a patient elects hospice, nor does it cover room and board in a nursing facility, emergency room visits not arranged by the hospice team, or medications unrelated to the terminal diagnosis. Understanding both sides of this coverage helps families plan with confidence and avoid unexpected gaps.

The Basics: What Is the Medicare Hospice Benefit?

The Medicare Hospice Benefit is a program under Medicare Part A that covers hospice care for eligible patients who have a terminal diagnosis with a life expectancy of six months or less if the illness runs its expected course, and who choose to shift the focus of care from curative treatment to comfort.

To receive this benefit, a patient must:

• Be enrolled in Medicare Part A
• Have a terminal illness certified by a physician
• Choose comfort-focused care rather than treatment aimed at curing the terminal illness
• Receive care from a Medicare-certified hospice provider

To understand whether your loved one meets the clinical criteria, visit: hospice eligibility guidelines.

What Medicare Covers in Hospice Care

• Physician and Medical Oversight. Medicare covers services from the hospice medical director and the patient’s attending physician when those services are related to the terminal diagnosis. This includes clinical oversight of the care plan, symptom management direction, and certification and recertification of hospice eligibility at each benefit period.
• Nursing Care. Registered nurse visits are fully covered under the Medicare Hospice Benefit. This includes scheduled visits to assess symptoms, manage pain, administer and monitor medications, and educate family caregivers on how to support their loved one between visits.
• Aide and Homemaker Services. Certified nursing aide visits for personal care, such as bathing, grooming, and comfort assistance, are covered under the benefit. Homemaker services for light tasks directly related to the patient’s care may also be included, depending on the care plan.
• Medical Social Services. Social work support is a covered component of the Medicare Hospice Benefit. This includes helping navigate advance directives, coordinating community resources, supporting family caregivers, and facilitating care-related conversations within the family.
• Spiritual Care and Counseling. Spiritual care and chaplaincy services are covered for both the patient and the family. This includes support from a hospice chaplain or spiritual care coordinator, regardless of religious affiliation, as well as dietary counseling and other counseling services related to the terminal illness.
• Bereavement Support. Bereavement care is covered for family members for at least 13 months following a patient’s death. This may include check-in calls, written correspondence, individual counseling sessions, and referrals to community grief resources. 
• Medications Related to the Terminal Diagnosis. Medicare covers medications that are directly related to the terminal diagnosis and focused on comfort and symptom management. This includes pain medications, anti-nausea drugs, anxiety management medications, and other drugs prescribed to control symptoms associated with the terminal condition. There may be a small copay of up to $5 per prescription for outpatient drugs related to pain and symptom management, though many hospices absorb or waive this cost.

Medical Equipment and Supplies

The Medicare Hospice Benefit covers durable medical equipment and supplies that are part of the hospice plan of care. This commonly includes:

• Hospital bed for use in the home
• Wheelchair or walker
• Bedside commode
• Oxygen equipment
• Wound care supplies (see our wound care services page for more on how this is managed)
• Catheters and related supplies
• Bandages, gloves, and other comfort-related medical supplies

Equipment and supplies are delivered to wherever the patient lives. Families do not need to arrange or pay for these separately.

Short-Term Inpatient Care

When a patient’s symptoms cannot be managed at home, Medicare covers a short-term stay in a Medicare-approved inpatient facility for pain and symptom management. This is known as General Inpatient Care and is one of the four levels of care covered under the hospice benefit. It is temporary and intended to stabilize the patient before returning home.

Respite Care

Medicare covers short-term respite care in an inpatient facility to give family caregivers a temporary break from caregiving responsibilities.

For families who are feeling stretched, this is an important and often underused benefit. Our volunteer support team can also help coordinate additional caregiver relief between respite periods.

What Medicare Does Not Cover in Hospice Care

Understanding the boundaries of the benefit is just as important as knowing what it includes. These are the areas where Medicare hospice coverage does not apply.

• Curative Treatment for the Terminal Illness. This is the most significant and most misunderstood boundary. When a patient elects the Medicare Hospice Benefit, Medicare stops covering treatments aimed at curing or slowing the progression of the terminal illness itself. This is not a penalty or a restriction. It reflects the core purpose of hospice, which is to shift the focus from trying to cure the disease to living as comfortably and fully as possible for the time that remains. Patients can revoke the hospice election at any time if they decide to pursue curative treatment again. Medicare coverage for curative treatment resumes when hospice is revoked. This is an important point for families who feel uncertain about the decision. Choosing hospice is not a permanent or irreversible commitment.
• Room and Board in a Nursing Facility. If a patient lives in a nursing home or assisted living facility, Medicare does not cover room and board costs through the hospice benefit. The hospice benefit covers the clinical and supportive services provided to the patient wherever they live, but the cost of the facility itself remains the patient’s or family’s responsibility, typically through private pay, Medicaid, or long-term care insurance.
• Emergency Room Visits Not Arranged by the Hospice Team. Under the hospice benefit, emergency room visits and ambulance transport are generally not covered unless they are arranged by the hospice provider or are unrelated to the terminal diagnosis. If a patient experiences a symptom crisis, the correct first call is to the hospice nurse, not to 911. The hospice team is equipped to manage most crises at home, which is usually where patients prefer to be.
• Hospital Stays Not Arranged Through the Hospice Provider. Inpatient hospital stays not coordinated by the hospice team are not covered under the hospice benefit for conditions related to the terminal diagnosis. If a patient is admitted to the hospital outside of the hospice plan of care, Medicare may bill the stay separately, which can create gaps in coverage.
• Care from Providers Not Affiliated with the Hospice. All care related to the terminal diagnosis must be provided through or coordinated by the enrolled hospice provider. If a patient sees a specialist or receives treatment for the terminal condition from an outside provider without the hospice team’s coordination, Medicare will generally not cover those services under the hospice benefit.
• Medications Unrelated to the Terminal Diagnosis. Medications prescribed for conditions that are separate from the terminal diagnosis are not covered under the hospice benefit but may continue to be covered under Medicare Part D. The hospice team will work with the patient’s care plan to clarify which medications fall under which benefit. If you have questions about a specific medication, the hospice medical director and nursing team can help your family understand how coverage applies to your loved one’s particular situation.

Let Us Walk You Through Your Coverage

Coverage questions should never be a barrier to getting the care your loved one deserves. Our team at Foundations Hospice will verify your loved one’s Medicare, Medicaid, or private insurance benefits before care begins and explain exactly what is covered in plain language, with no pressure and no obligation.

We serve families across Southeast Louisiana, including Livingston, St. Tammany, East and West Baton Rouge, Ascension, Jefferson, Orleans, and surrounding parishes. Care is provided wherever your loved one calls home, with a team available around the clock.

Call (225) 209-5629 to speak with a member of our care team today, or schedule a care consult at a time that works for you.