California

Medicare Hospice Coverage: Home Care vs Inpatient Care

December 1, 2025 by Orange Hospice

If your loved one qualifies for the Medicare Hospice Benefit, Medicare Part A covers most hospice services in Orange County. You can receive care at home or, when symptoms become difficult to manage, in an inpatient setting for short periods.

This guide explains what Medicare covers in each setting, what costs you might still see, and how to decide where care should happen.

What Medicare’s Hospice Benefit Includes

Hospice is specialized, comfort-focused care for people living with a life-limiting illness. The goal is relief from pain and distressing symptoms, emotional and spiritual support, and guidance for family caregivers. Medicare Part A covers hospice when you choose comfort-focused care and your hospice and attending physician certify a life expectancy of six months or less if the illness runs its normal course.

Once you elect hospice, Medicare covers what is needed to manage the terminal illness and related conditions. Services include visits from your interdisciplinary team, medications for symptom control, medical equipment and supplies, and caregiver support such as education and bereavement services. Medicare pays hospices a daily rate for one of four levels of care: routine home care, continuous home care, general inpatient care, and inpatient respite care.

Key takeaway: Medicare pays the hospice to take care of you wherever you are, using one of four coverage levels that match your needs on a given day.

Home Hospice Care: What is Covered

Most people receive hospice at home. Medicare typically covers:

Clinical visits from nurses, physicians, nurse practitioners, social workers, chaplains, and trained volunteers.
Home health aide support for personal care such as bathing and grooming.
Medications related to the hospice diagnosis for pain and symptom relief.
Durable medical equipment such as a hospital bed, wheelchair, oxygen, suction, and walker.
Medical supplies such as incontinence products, dressings, and gloves.
Caregiver support including teaching, 24/7 on-call availability, and grief support after a death.

Possible out-of-pocket costs at home:

Co-pay up to a small amount per prescription for outpatient medications related to the hospice diagnosis.
Room and board in a facility is not covered by Medicare hospice. If you live in an assisted living or skilled nursing facility and receive routine home hospice there, Medicare pays the hospice for care, but the residence fees are separate.
Non-hospice items unrelated to the terminal illness may be billed to your other Medicare benefits and carry their usual copays or deductibles.

For a clear breakdown of when Medicare covers hospice nd when small copays can apply, read Is Hospice Fully Covered by Medicare? What “100% Coverage” Really Means.

Inpatient Hospice Care: When and Why it is Used

Sometimes symptoms become too intense to manage at home. In that situation, your hospice team can arrange general inpatient care for short-term, round-the-clock management in a hospital or hospice unit. The goal is to stabilize symptoms so you can return home safely.

What Medicare covers for inpatient hospice:

24-hour nursing and medical care focused on comfort and symptom control.
Medications, supplies, and equipment during the stay.
Care by the same hospice team that sees you at home.

What you may pay:

No daily copay for covered inpatient hospice services.
The facility room and board is covered during general inpatient care because it is part of the inpatient hospice level.
Transportation arranged by the hospice for an approved inpatient transfer is covered when medically necessary.

Caregiver relief through respite care:

Medicare allows inpatient respite care for up to five days at a time to give family caregivers a rest. You may pay 5% of the Medicare-approved amount for respite days, with a cap equal to the inpatient hospital deductible for the year. Respite does not require uncontrolled symptoms. It is designed to support caregivers.

Continuous Home Care During a Crisis

If you prefer to remain at home during a symptom crisis, Medicare can cover continuous home care for short periods. This level provides extended nursing presence at home to control acute symptoms such as severe pain, breathlessness, nausea, or agitation. The goal is the same as inpatient hospice: stabilize and return to routine home care once symptoms improve.

Side-by-Side Comparison

Feature	Home Hospice (Routine)	Continuous Home Care	Inpatient Hospice	Inpatient Respite
Primary purpose	Ongoing support at home	Crisis symptom control at home	Crisis symptom control in facility	Short caregiver break
Location	Home or residence	Home or residence	Hospital or hospice unit	Hospital, SNF, or hospice unit
Staffing	Scheduled visits	Hourly, extended bedside nursing	24/7 nursing and medical care	24-hour care
Typical duration	Weeks to months	1 to 3 days	Several days	Up to 5 days
Medicare costs	No daily copay for covered care; small Rx copays may apply	No daily copay	No daily copay	5% coinsurance up to annual cap

What Medicare Does Not Cover Under Hospice

Curative treatments for the terminal illness. Hospice focuses on comfort and quality of life.
Room and board in assisted living or nursing homes during routine home hospice.
Emergency department or hospitalizations that you seek without hospice coordination for issues related to the terminal illness.
Care unrelated to the terminal illness under the hospice election may be billed to your standard Medicare coverage and may involve deductibles or coinsurance.

How To Decide Between Home and Inpatient Care

Use the following prompts with your hospice nurse or physician:

Are symptoms under control with the current plan? If yes, stay at home with routine care.
Are symptoms escalating despite added visits or new medications? Ask whether continuous home care or a short inpatient stay is appropriate.
Is the caregiver exhausted or at risk? Consider a respite stay for up to five days.
Will a brief inpatient admission likely return you to comfort at home? If yes, your team can arrange and oversee the transfer.

Common scenarios for Orange County families

Severe pain after a medication change. Your nurse increases visit frequency, starts continuous home care overnight, and stabilizes pain so you can remain at home.
Sudden breathing distress. Your team arranges general inpatient care in a nearby facility for rapid treatment with intravenous medications and respiratory support. After two days, you return home on a new plan.
Caregiver burnout. Your loved one uses a three-day respite stay to allow the family to rest and reorganize supports.

Frequently Asked Questions

Can you switch between home and inpatient care?
Yes. Medicare allows your level of care to change as your needs change. Your hospice team reassesses daily and coordinates any transfer.
Will you lose your doctor?
No. Your attending physician can stay involved. Your hospice medical director oversees the hospice plan with your consent.
Does hospice provide 24-hour caregivers at home every day?
Not as a routine. Hospice provides scheduled visits and 24/7 on-call support. Extended bedside care happens only during continuous home care for a symptom crisis.
What if you live in assisted living or a nursing home?
Routine home hospice can be delivered there. Medicare covers hospice services. The residence fee is separate, since it is room and board.

Local Guidelines for Orange County families

You can receive hospice wherever you call home in Anaheim, Buena Park, Irvine, Santa Ana, Huntington Beach, Tustin, and neighboring communities. When short-term inpatient care is needed, your hospice coordinates placement in a local hospital or hospice unit and arranges the return home once symptoms are controlled.

How Orange Hospice Supports Your Choice

Choosing where to receive hospice care is deeply personal. Orange Hospice is here to honor your preferences, keep you comfortable, and make each step easier for your family.

Same team across settings. You see familiar clinicians whether you are at home or temporarily inpatient.
Rapid response. Nurses are available 24/7 for urgent needs.
Caregiver-first planning. We teach, supply equipment, and check on caregiver wellbeing at every visit.
Seamless transitions. If inpatient care is needed, we handle the details and keep you informed.

Call Today for Guidance

Call (714)790-0594 or send us a message here for a no-pressure conversation about eligibility, coverage, and care at home or inpatient. We serve Orange County and surrounding areas. We coordinate support across home and inpatient settings for families in Orange County.

Hospice Care Costs: What Medicare Covers and What It Does Not

December 1, 2025 by Orange Hospice

Medicare provides essential health coverage for adults 65 and older as well as some younger individuals with disabilities or end-stage renal disease, helping pay for hospital care, doctor visits, and medications. This provision connects patients to hospice by covering most services related to the terminal illness, from medications and equipment to interdisciplinary visits.

When you choose the Medicare Hospice Benefit, most end-of-life care related to the terminal illness is covered under Part A. You usually pay nothing for covered hospice care, although small copays can apply for certain prescriptions and a limited share of the cost for inpatient respite care. This guide explains what Medicare pays for at home and in inpatient settings, what it does not cover, and how families in Orange County can plan ahead.

At a Glance: What You Pay

$0 for covered hospice care from a Medicare-certified hospice.
Up to a $5 copay per outpatient prescription for pain and symptom control when supplied by hospice.
5% coinsurance for inpatient respite care, subject to an annual cap based on the Medicare-approved amount.
Usual Medicare cost sharing for care unrelated to the terminal illness.

What “Hospice” Means in Medicare

Hospice is comfort-focused care for someone with a life-limiting illness who elects to stop curative treatment for that illness. You qualify when your hospice physician and your attending physician certify a life expectancy of six months or less if the illness follows its usual course. Care is delivered where you live or, if needed, in an inpatient unit for short periods to manage uncontrolled symptoms.

What Medicare Covers Under Hospice

Medicare pays the hospice a daily rate for one of four levels of care. Covered services are broad and are designed to manage the terminal illness and related conditions.

Common covered items and services

Visits by nurses, hospice physicians or NPs, social workers, chaplains, aides, and trained volunteers
Medications related to the terminal diagnosis for pain and symptom control
Durable medical equipment, such as a hospital bed, oxygen, wheelchair, and walker
Medical supplies, such as dressings and incontinence products
24/7 on-call support and crisis response
Bereavement services for the family after a death

The four Medicare hospice levels

Routine home care. Ongoing support where you live.
Continuous home care. Extended nursing in the home during a symptom crisis.
General inpatient care. Short inpatient stay for complex symptom control.
Inpatient respite care. Brief inpatient stay to give caregivers rest.

Most days of care are billed as routine home care, with short periods of other levels when symptoms escalate or caregivers need a break.

What Medicare Does Not Cover Under Hospice

Room and board for routine home hospice in assisted living or a nursing facility. You remain responsible for residential fees.
Curative treatments for the terminal illness after electing hospice.
24-hour caregiver presence at home every day. Extended bedside care happens only during continuous home care for a short crisis.
Unrelated services. Care not related to the terminal illness may be billed to regular Medicare benefits and can carry normal cost sharing.

Medications: Who Pays and When

Hospice-covered drugs. You may pay up to a $5 copay for each outpatient prescription related to symptom management related to the terminal illness.
Drugs not covered by the hospice benefit. In rare cases, the hospice will coordinate with your Part D plan to determine coverage. Your hospice should tell you in advance if something is not covered and whether you may owe a share.

Equipment and Supplies

If your plan of care requires equipment or supplies for symptom management, the hospice provides and maintains them. Examples include a hospital bed, oxygen, suction, or commode, plus wound dressings and protective supplies. These are included in the hospice per-diem and do not create separate bills for you.

Transportation and ambulance services

Transportation arranged by hospice that is part of your hospice care plan is typically covered; such as transfer to a facility and transfer home from a facility. Medicare covers ambulance transport only when other transportation would endanger your health and to the nearest appropriate facility. For nonemergent trips, the ambulance company may issue an Advance Beneficiary Notice of Noncoverage (ABN) if Medicare is unlikely to pay. If you sign an ABN, you agree to pay for the service if Medicare denies payment.

Inpatient Costs: Symptom Control vs Respite

General inpatient care. When symptoms cannot be controlled at home, Medicare covers the inpatient stay and services with no daily copay.
Inpatient respite care. Families may use short respite stays. You may pay up to 5% of the Medicare-approved amount, with a yearly cap.

Other Health Needs

You can still receive treatment for conditions not related to the terminal illness. Those services may be billed to your regular Medicare benefits, which means normal Part A or Part B cost sharing can apply. Your hospice team helps determine what is related and what is not and will inform you of any costs.

How To Plan Ahead and Avoid Surprises

Ask for a coverage talk at admission. Request a plain-language list of what is covered, typical copays, and any common exclusions for your situation.
Clarify medications. Ask which drugs are covered by hospice and which may fall to your Part D plan.
Review residential costs. If you live in assisted living or a nursing facility, plan for ongoing room and board.
Discuss crisis options. Learn when continuous home care or a brief inpatient stay will be used and how transfers work.
Keep one point of contact. Know who to call 24/7 for urgent needs or billing questions.

Hospice for Families in Orange County

You can receive routine home hospice where you live in Anaheim, Buena Park, Irvine, Santa Ana, Huntington Beach, Tustin, and neighboring communities. When symptoms require short-term inpatient care, your hospice coordinates admission to a local hospital or hospice unit and arranges your return home once you are stable.

How Orange Hospice Supports Orange County Families

Orange Hospice provides care with coordinated support across home and inpatient settings, we stay focused on what matters most to you and provide the right level of care at the right time.

Same team across settings. You see familiar clinicians whether you are at home or temporarily inpatient.
Rapid response. Nurses are available 24/7 for urgent needs.
Caregiver-first planning. We teach, supply equipment, and check on caregiver wellbeing at every visit.
Seamless transitions. If inpatient care is needed, we handle the details and keep you informed.

Frequently Asked Questions

Is hospice really covered at 100 percent?
For covered hospice services related to the terminal illness, yes. Small copays can apply for certain outpatient prescriptions, and you may pay 5 percent for respite care.
Can I move between home and inpatient care?
Yes. Your level of care changes as needs change, always with the goal of keeping you comfortable.
Does hospice replace my other Medicare coverage?
Hospice covers services for the terminal illness and related conditions. Unrelated care can still be billed to your regular Medicare benefits with their usual cost sharing.

Orange County Hospice: Call for Guidance

Speak with our Orange Hospice care team now to review what Medicare covers in hospice, where small copays may apply, and how to plan for items that are not included. Call (714) 790-0594 for a calm conversation about eligibility, medications, equipment, inpatient respite, and next steps. We serve families throughout Orange County and neighboring communities.

How to Qualify for the Medicare Hospice Benefit: Eligibility, Recertification, and What to Expect

October 23, 2025 by Orange Hospice

If you or your loved one live in Orange County and are considering hospice, here is the quick truth. To qualify under Medicare Part A, a hospice physician and your doctor certify a life expectancy of six months or less if the illness runs its normal course, you choose comfort-focused care rather than curative treatment for the terminal illness, and you sign a statement electing hospice. Most families pay $0 for covered hospice services, with small copays possible for certain outpatient medicines and short-term respite care.

This guide walks you through eligibility, how to elect the benefit, what recertification involves, what costs to expect, and how hospice services work in Orange County so you can plan with peace of mind.

Who Qualifies For The Medicare Hospice Benefit

You qualify if you have Medicare Part A and meet all of the following:

Terminal prognosis: Your hospice doctor and your regular doctor certify that life expectancy is six months or less if the illness runs its normal course.
Care focus: You accept comfort care rather than treatment intended to cure the terminal illness and related conditions.
Election of hospice: You sign a statement choosing hospice in place of Medicare-covered treatments for the terminal illness and related conditions.

Under federal rules, electing hospice waives payment for curative services related to the terminal illness from non-designated providers during the election period. Care for unrelated conditions remains covered by Medicare as usual.

How Benefit Periods And Recertification Work

Medicare structures hospice coverage in timed periods:

First 90 days
Second 90 days
Unlimited 60-day periods after that, as long as you remain eligible.

Face-to-face requirement – Beginning with the third benefit period (day 180) and at each subsequent recertification, a hospice physician or hospice nurse practitioner must complete a face-to-face encounter within the 30 days before the new period starts. Their clinical findings support the recertification that life expectancy remains six months or less.

Certification timing – The hospice must obtain physician certification by the end of day 3 of each benefit period. Initial certifications and recertifications can be completed up to 15 days before the next period begins.

If you stabilize or improve – You may be discharged alive if you no longer meet eligibility. You can return to hospice later if you again qualify. This is common and it is allowed.

What You Pay Under Medicare

Most families pay nothing for covered hospice services from a Medicare-approved hospice. There are a few exceptions:

Outpatient medications for symptom control and pain relief may have a copay up to $5 per prescription.
Inpatient respite care may have 5% coinsurance, not exceeding the yearly inpatient hospital deductible.
Room and board at residential settings is generally not covered, unless you are receiving general inpatient or respite care arranged by your hospice.
Care for unrelated conditions continues under Medicare, with any normal deductibles and coinsurance.

What Is Covered Vs. Not Covered

Covered when related to the terminal illness and arranged by your hospice:

Visits from nurses, physicians, aides, social workers, and chaplains
Pain and symptom management, medical equipment, and supplies
Short-term inpatient care for symptom crises
Respite care for caregivers, up to 5 days at a time, when arranged by your hospice
Grief and bereavement support for your family

Not covered once you elect hospice:

Treatments intended to cure your terminal illness and related conditions
Prescription drugs aimed at cure rather than symptom relief
Room and board in a facility, except when Medicare covers an arranged inpatient level of care
Care from other hospices that is not arranged by your elected hospice

Step-By-Step: How To Elect The Hospice Benefit

Talk with your doctor and the hospice: Confirm that the medical criteria are met and discuss your goals.
Review and sign the hospice election statement: This names the hospice, confirms you understand hospice is palliative rather than curative, and explains what Medicare services you waive during the election period.
Create your plan of care: You, your family, and the hospice team set goals and visit schedules.
Start services: Equipment and medications related to the terminal illness are delivered or arranged by the hospice.
Know your rights: You may change hospice providers once per benefit period. You can also revoke hospice if you decide to pursue curative treatment, and you may re-elect later if you qualify again.

Recertification Checkpoints At A Glance

Days 1-90: Initial period with certification on file.
Days 91-180: Second 90-day period with recertification.
Day 180 and beyond: Each 60-day period requires recertification plus a face-to-face clinical visit within the 30 days before the period starts.

Tip for caregivers: Put the next recertification date on your calendar and ask your nurse to confirm when the face-to-face is scheduled. That keeps the benefit continuous without gaps.

What To Expect From Your Hospice Team In Orange County

A plan that matches your goals: Comfort, safety, and dignity at home, in assisted living, or in a nursing facility.
24/7 phone support: Nurses guide you through nighttime changes to help avoid unnecessary ER visits.
Rapid response for symptom spikes: Visits increase when you need more help.
Caregiver support: Education, hands-on teaching, and short-term respite options that we can help arrange.

If you are new to the idea of taking a break, read our practical micro-respite tips and learn how to qualify for respite care so you can step away with confidence.

FAQs

Can I keep my primary doctor involved?
Yes. You can designate an attending physician who continues to guide your care along with the hospice.

What if I am in a Medicare Advantage plan?
Your plan helps you locate a Medicare-approved hospice. Once you elect hospice, Original Medicare covers services related to the terminal illness, and your plan can still cover unrelated services and extras if you keep paying premiums.

Can I continue medications that feel curative?
Medications for symptom control and quality of life may be covered. Drugs intended to cure the terminal illness are not covered under the hospice election. Ask your nurse or doctor to review each medication with you.

What happens if I live longer than six months?
You can remain on hospice as long as you continue to meet eligibility at each recertification. There is no hard stop.

What if my condition improves?
If you no longer meet eligibility, you may be discharged from hospice. You can return later if you again qualify.

A Quick Checklist Before You Elect Hospice

Ask your doctor if the six-month prognosis standard applies in your case.
Confirm the hospice is Medicare-certified and serves your city in Orange County.
Review the election statement and what you are waiving.
Clarify your likely out-of-pocket costs for outpatient meds and possible respite copays.
Put the recertification window and the face-to-face date on your calendar.

Next Steps For Orange County Families

If you are in Anaheim, Santa Ana, Irvine, Huntington Beach, or nearby cities, call the Orange Hospice team to review eligibility and start your plan of care. We coordinate with your physicians, arrange equipment and supplies, and teach you what to expect in the first week.
If you care for someone at home and need breaks, ask about inpatient respite or volunteer options. We will help you understand copays and availability.

Learn Medicare Hospice Eligibility in Orange County: Call Us

Have questions about how to qualify for the Medicare hospice benefit, recertification, or what to expect? Call (714) 790-0594 or visit our contact page. Our team explains eligibility, timelines, and services for families in Orange County and Anaheim, and helps you take the next step with assurance.

Bridging Faith and Comfort: Spiritual Care in End-of-Life Settings

October 23, 2025 by Orange Hospice

Nearing the end of life often follows recognizable patterns, and questions about meaning, legacy, and faith often surface. Spiritual care in Orange County meets you in those moments. You receive support that honors your beliefs, your stories, and your family’s traditions. This guide shows you what to expect, how spiritual care supports meaning and comfort, and how to align choices with your values so you can handle end of life care in Orange County with confidence.

What Spiritual Care Means in Hospice

Spiritual care is about honoring what gives you strength, whether that is a specific faith, nature, art, family stories, or quiet reflection. Hospice chaplains and spiritual counselors listen, assess, and walk with you and your family so you feel seen and supported. They collaborate with nurses, physicians, social workers, and bereavement specialists to reduce distress and improve quality of life.

Core Elements You Can Expect

Respect for all traditions and none. Care supports any faith, interfaith practice, or secular worldview.
Assessment of spiritual needs. Your beliefs, values, hopes, worries, and rituals are documented and revisited over time.
Rituals and life review. Prayer, scripture, meditation, chants, blessings, anointing, or simple presence, based on your preferences.
Family meetings and caregiver support. Guidance for difficult conversations, forgiveness, and legacy activities that involve loved ones
Bereavement follow-up. Ongoing grief and spiritual support after a death.

How Spiritual Care is Integrated Into Your Plan of Care

Medicare requires hospices to assess spiritual needs and provide counseling as part of core services. That means spiritual goals are written into the plan of care and updated as needs change. The team coordinates with your personal clergy or community, and can arrange specific clergy or ritual support when requested.

What that looks like in practice

A chaplain completes a spiritual history during admission and shares relevant insights with the team to guide daily care.
The plan may include scheduled chaplain visits, family meetings before key decisions, and coordination for faith-specific sacraments or rites.
When symptoms escalate, the chaplain works alongside nursing to reduce fear and support coping for the patient and family.

Recognizing Spiritual Distress

Spiritual distress is common at the end of life. It can sound like “Why is this happening?” or “Have I done enough?” or “I am afraid to leave my family.” Screening questions endorsed in primary care and palliative settings help identify needs early, which reduces anxiety and improves satisfaction with care.

Signs to share with your team

Loss of meaning or hope
Conflict between beliefs and medical choices
Desire for reconciliation or unfinished conversations
Requests for specific rituals or last rites

If you notice these signs, begin a gentle conversation with your loved one and gradually turn the talk into thinking about starting hospice care and spiritual support.

Rituals and Traditions: Honoring What Matters To You

Orange County families are culturally and spiritually diverse. Your team can help with:

Faith-specific clergy for Catholic sacraments, Buddhist chanting, Muslim prayers, Jewish rituals, Protestant communion, or LDS blessings.
Culturally meaningful practices, such as family altar set-up, ancestor honoring, or music and poetry that carry personal meaning.
Bilingual coordination and interpreters when needed, so nothing important is lost in translation.
At-the-bedside presence during active dying, including vigil support that respects spiritual boundaries and preferences.

How Spiritual Care Supports Caregivers

Caregivers carry a heavy emotional load. Spiritual counseling offers:

Language for difficult moments. You learn ways to speak about hope, comfort, and goodbye.
Tools for anticipatory grief. Guided reflection, prayer or meditation, and meaning-making practices can reduce helplessness.
Connection to community. Your team can link you to your own clergy or supportive groups, which is especially valuable after the funeral.

Evidence-informed Spiritual Care

Current palliative care guidelines and peer-reviewed literature support spiritual care as part of whole-person care, with benefits for quality of life, decision making, and caregiver outcomes. Programs that use structured assessment and integrate chaplains into the interdisciplinary team deliver more consistent support.

What Families Often Cannot Find Elsewhere

Local hospices commonly say spiritual care is “available,” but details about how it works are limited. Here is what you should expect and ask for:

A clear spiritual assessment process at admission, with updates as conditions change. Ask what questions are used and where the information is recorded.
Defined visit frequency for chaplains and how urgent needs are handled after hours
Coordination with personal clergy and access to multi-faith rituals without delays.
Inclusion in the IDT plan of care so spiritual goals influence symptom management, social work support, and caregiver education.
Post-death bereavement follow-through that covers spiritual as well as emotional needs.

How Spiritual Care Works With Orange Hospice

In Orange Hospice, you receive compassionate support that fits your beliefs and preferences. Call (714) 790-0594 or visit our contact page to learn how spiritual care can help today. Services include spiritual guidance, family meetings, spiritual screening, reflective listening, help connecting with your personal clergy, and clergy or ritual support when requested.

These services are part of your hospice plan of care and available across our service areas in Orange County and nearby communities.

FAQs

Is spiritual care only for religious people?
No. Spiritual care meets you where you are, including secular or non-religious beliefs.
Is spiritual care covered by Medicare?
Yes. Spiritual counseling is a core hospice service and is included as part of the Medicare Hospice Benefit.
Can we include our own clergy?
Yes. Your team can coordinate visits and rituals with your clergy or faith community.
Do chaplains visit after hours or during a crisis?
Your hospice team provides 24/7 access. Ask how urgent spiritual needs are handled nights and weekends so you know whom to call.

Speak With our Spiritual Care Team Today

Call (714) 790-0594. You can also request a care consultation on our contact page. Spiritual care is part of whole-person hospice care and is available across Orange County and surrounding communities.

Is Hospice Fully Covered by Medicare? What “100% Coverage” Really Means In Orange County

October 23, 2025 by Orange Hospice

For most families in Orange County, Medicare Part A covers nearly all hospice services once you elect the hospice benefit. You generally pay $0 for covered hospice care. Small costs can still apply for certain outpatient medications and short-term respite care, and room and board is not covered in most residential settings. Below is a practical, fact-checked guide based directly on Medicare’s official pages and manuals so you can plan with confidence.

What Medicare Means by “Fully Covered”

When people say hospice is “100% covered,” they mean the Medicare Hospice Benefit under Part A. If you qualify and choose hospice, Medicare pays the hospice for all covered services in your plan of care for the terminal illness and related conditions. There is no Part A deductible for hospice itself, and most families pay nothing for covered care arranged by the hospice in Orange County.

What You May Still Pay

Medicare lists a few limited costs that can apply:

Up to $5 copay per outpatient prescription for pain and symptom control when filled at home. If a drug is not covered under the hospice benefit, your hospice must check whether your Part D plan can cover it and tell you in advance if there will be a charge.
5% coinsurance for inpatient respite care to give caregivers a short break. Your coinsurance cannot exceed the inpatient hospital deductible for the year.
Room and board is not covered if you live at home, in assisted living, or in a nursing facility. Medicare pays room and board only when the hospice team arranges and authorizes a short, qualifying general inpatient or respite stay.

For a quick reference, Medicare’s costs page repeats the same rules: $0 for covered hospice services, up to $5 per outpatient prescription, and 5% for respite.

Who Is Eligible and How Long Hospice Lasts

You qualify when all of these are true:

You have Medicare Part A.
Your hospice physician and your regular doctor certify a life expectancy of 6 months or less if the illness runs its usual course.
You choose comfort-focused care instead of curative treatment for the terminal illness and sign an election of hospice.

Coverage is structured as two 90-day benefit periods, followed by unlimited 60-day periods as long as the hospice physician recertifies eligibility.

What Medicare Hospice Covers

When related to the terminal illness and included in your hospice plan of care, Medicare covers:

Clinical visits from nurses, doctors, social workers, chaplains, and hospice aides
Medications for symptom control and pain relief
Durable medical equipment and supplies like hospital beds, oxygen, wheelchairs, incontinence and wound supplies
Therapies needed for comfort and safety if ordered in the plan of care
Ambulance related to the terminal illness when added to the plan of care
Four levels of care paid per diem by Medicare: routine home care, continuous home care during a crisis, general inpatient care, and short-term inpatient respite care

Medicare expects the hospice in Orange County to provide any service in the plan of care that is reasonable and necessary for palliation of the terminal illness and related conditions.

What Is Not Covered

Once you elect hospice, Medicare will not pay for:

Curative treatments for the terminal illness
Prescription drugs that aim to cure the illness
Room and board in your home, assisted living, or a nursing facility
Duplicate hospice services from a second hospice you did not choose (unless you formally transfer)

“Unrelated” Care and How to Get Clarity

Original Medicare continues to cover non-hospice-related problems, and you would owe any usual deductibles or coinsurance for those unrelated services. You can ask your hospice for a written list of items, services, and drugs they consider not related to your terminal illness. Medicare requires hospices to provide this list within 3–5 days of your request and to share it with outside providers or Medicare if asked.

Medicare Advantage and Hospice

If you are in a Medicare Advantage (Part C) plan and choose hospice, Original Medicare takes over payment for hospice services. You can stay enrolled in your plan for any non-hospice benefits and must keep paying your plan premiums. Your plan must help you find a Medicare-approved hospice, and Original Medicare covers items and services related to the terminal illness once hospice starts, even if you stay in your plan.

How the Four Medicare Levels of Hospice Care Work

Medicare pays a daily rate that depends on the level of care documented in your plan of care:

Routine Home Care: Most common. Ongoing hospice support where you live.
Continuous Home Care: For crisis periods at home requiring at least 8 hours of predominantly nursing care in a 24-hour period to manage acute symptoms. Cannot be provided in an inpatient facility.
General Inpatient Care: Short-term hospital, hospice inpatient unit, or skilled nursing facility stay when symptoms cannot be managed at home.
Inpatient Respite Care: Up to 5 days to relieve caregivers. 5% coinsurance applies.

Medications: Hospice Benefit vs. Part D

Most medications for pain and symptom management are covered by the hospice and may carry up to a $5 copay if filled as outpatient prescriptions. If a drug is not part of hospice coverage, your hospice must check for Part D coverage and notify you in advance if a cost will apply. This helps avoid surprise bills at the pharmacy.

Care Settings and Room-and-Board Rules

You can receive hospice where you live, including your home, assisted living, or a nursing facility. Medicare does not pay room and board in these settings. When the hospice team arranges a qualifying general inpatient or respite stay, Medicare covers the facility stay for that short period. If you go to a hospital without hospice arranging it and the care is related to the terminal illness, you may be responsible for the hospital charges. Always call your hospice first.

Common Orange County Scenarios

At home in Anaheim: You pay $0 for covered visits, equipment, and supplies in your plan of care. You may pay up to $5 for a new outpatient medication picked up at your local pharmacy.
In a nursing facility in Irvine: The hospice provides clinical care, medications, equipment, and supplies related to the terminal illness. Facility room and board is your responsibility except during hospice-arranged inpatient or respite stays that qualify.
Caregiver break in Fullerton: Your loved one uses inpatient respite for several days. Expect 5% coinsurance, capped by the inpatient deductible for the year.

Medicare Hospice Coverage in Orange County: Get Clear Answers Today

Call Orange Hospice at (714) 790-0594. We can review your Medicare benefits, confirm any expected costs, and coordinate a plan of hospice care for your family anywhere in Orange County and nearby communities.