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.
