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

1. 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.
2. Clarify medications. Ask which drugs are covered by hospice and which may fall to your Part D plan.
3. Review residential costs. If you live in assisted living or a nursing facility, plan for ongoing room and board.
4. Discuss crisis options. Learn when continuous home care or a brief inpatient stay will be used and how transfers work.
5. 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.