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What are the Specific Requirements for Medicare Hospice Coverage?

To qualify for Medicare hospice coverage, patients must meet several specific criteria regarding their health status and treatment preferences:

  • Terminal Illness Certification: A physician and the hospice medical director must both certify that the patient is terminally ill. This is generally defined as having a life expectancy of six months or less if the disease follows its natural course.
  • Election of Hospice Care: The patient must formally choose hospice care, which involves signing a statement to waive Medicare Part A coverage for curative treatments related to the terminal illness. The focus shifts entirely to comfort and quality of life.
  • Recertification Requirements: Coverage is provided in benefit periods. After the initial 90-day period, the patient must be recertified for a second 90-day period. This is followed by 60-day intervals thereafter. At each interval, a physician must confirm the patient still meets the six-month prognosis criteria.
  • Location and Costs: While Medicare Part A covers clinical services (such as nursing care, medical equipment, and medications for the terminal illness), it typically does not cover room and board if the patient remains in their private residence or an assisted living facility. However, room and board may be covered if the patient resides in a Medicare-certified nursing home.

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