Medicare and Hospice: What Part A Pays and What Texas Families Should Know

Few Medicare decisions are as personal as choosing hospice. It's also a benefit many families don't learn about until they need it, sometimes while juggling a long drive between a parent's home and the nearest city hospital. Here's how Medicare Part A covers hospice, in plain terms.

Who qualifies

You can get hospice through Part A if:

• You have Part A
• Your hospice doctor and your regular doctor (if you have one) certify that you're terminally ill, with a life expectancy of 6 months or less
• You accept comfort care (palliative care) instead of treatment meant to cure the illness
• You sign a statement choosing hospice instead of other Medicare-covered treatment for your terminal illness

Where care happens

Hospice comes to you. Care can be delivered at home, which for many Texans means a farmhouse or a small-town home far from a hospital, or in a facility such as an assisted living community, nursing home, or inpatient hospice facility.

What Medicare covers

Hospice is a team approach. Your plan of care can include:

• Doctor and nursing services
• Medical equipment, like hospital beds and wheelchairs
• Medical supplies
• Drugs for pain and symptom control
• Physical, occupational, and speech therapy
• Social work and dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care for pain or symptom management
• Respite care: a short inpatient stay, up to 5 days at a time, so a family caregiver can rest

What it costs

Hospice cost	What you pay
Hospice care	$0
Outpatient drugs for pain and symptom relief	Up to $5 per prescription
Inpatient respite care	5% of the Medicare-approved amount

What it doesn't cover

• Room and board at home, in a nursing home, or in an inpatient hospice facility, except short respite or inpatient stays the hospice team arranges
• Treatment or drugs meant to cure the terminal illness
• Care from providers the hospice team didn't arrange
• ER visits, hospital care, and ambulance rides related to the terminal illness, unless the hospice team arranges them

That last point is worth planning for. If you live far from town, ask the hospice team who to call first when something changes at night, so a 911 call or ER trip doesn't leave you with the full bill. Medicare advises contacting your hospice team before getting any of these services.

The room-and-board point surprises many families, too. If a loved one lives in a nursing home or assisted living, hospice covers the care, not the monthly rent. For people with limited income, Texas Medicaid may help with some long-term care costs, which you can learn about through Texas Health and Human Services.

How long hospice lasts

Hospice is organized in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. A hospice doctor or nurse practitioner recertifies that you still qualify, including a face-to-face visit once you've had hospice for 6 months.

You can change hospice providers once during each benefit period.

If you have Medicare Advantage

Choosing hospice doesn't mean you have to leave your plan. While you're in hospice, Original Medicare covers everything related to your terminal illness. Your Medicare Advantage plan can still cover care for other conditions. See our Medicare Advantage vs. Original Medicare guide for how the two differ.

Getting help in Texas

• Compare providers: Medicare's Care Compare tool at Medicare.gov/care-compare lists Medicare-approved hospice providers near you, with quality information. In rural areas, ask each one which counties its team actually serves.
• Free counseling: Texas HICAP counselors can explain hospice benefits at 1-800-252-9240.
• Spanish help: You can call 1-800-MEDICARE (1-800-633-4227) and ask for an interpreter, and ask hospice providers whether Spanish-speaking staff are available.

To learn how hospice fits with the rest of your hospital coverage, read our guide to Medicare Part A.