Does Medicare Pay for Hospice Care in a Skilled Nursing Facility?

Many times, those living with a serious illness need a level of care beyond what is possible in their home. In these cases, a skilled nursing facility (SNF) may provide support with their complex healthcare needs. However, during a skilled nursing facility stay, the question of hospice care may come up. Does Medicare cover hospice in a skilled nursing facility if a patient or their authorized healthcare decision-maker is considering this type of care?

Understanding the Medicare Hospice Benefit

Hospice care provides compassionate support to people with terminal illnesses and their loved ones, focusing on comfort and quality of life instead of trying to cure their illness.

To understand Medicare coverage for hospice services in a skilled nursing facility, it is first important to learn the basics of the Medicare hospice benefit.

Someone qualifies for the Medicare hospice benefit if they are covered under Medicare Part A and meet the following criteria: [1]

• Their physician (and a hospice doctor) certifies that the person has a terminal illness with a life expectancy of six months or less
• They choose to stop curative treatment and only receive care for pain and symptom management for comfort
• They sign a statement saying they are choosing hospice care instead of other treatments for their diagnosis

Once hospice care begins, a doctor must recertify that the patient is eligible for hospice care every benefit period.

Medicare coverage for hospice care pays as follows:

• Care from Medicare-approved hospice providers is fully covered
• Prescription coverage extends to medications for pain and symptom relief related to the terminal illness. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
• Inpatient respite care is covered within the Medicare benefit. A small copay may be required.
• Medical care for health concerns not related to a person’s terminal illness can still be covered by their original Medicare coverage.

Patients always have the right to stop hospice care at any time by notifying their care provider, at which time their original Medicare coverage can resume.

Medicare Coverage for Hospice in a Skilled Nursing Facility

Medicare hospice benefits extend to care in a skilled nursing facility, with certain exceptions. It’s important to understand what is covered by the hospice benefit in a skilled nursing facility, and what is not.

First, the patient must be eligible for hospice care as certified by a physician. Secondly, the skilled nursing facility must have a contract with a Medicare-approved hospice agency to provide hospice care. [2]

Services Included in Medicare Hospice Coverage at a Skilled Nursing Facility

While at a skilled nursing facility, Medicare hospice coverage may pay for:

• Nursing care
• Medications for pain and symptom management
• Equipment and supplies for a terminal illness and related conditions
• Bereavement counseling for patient and loved ones
• Physical, occupational and speech therapy if needed
• Home health aides
• Dietary counseling if needed
• Social worker and chaplain support
• Hospice coordinates care with the nursing facility staff and other medical providers.
• Hospice also provides education to patients, families, and facility staff about the patient's condition and care. 

Services Not Included in Medicare Hospice Coverage at a Skilled Nursing Facility

There are a few things that hospice coverage will not pay for in a skilled nursing facility:

• Room and board
• Health care services not related to the terminal condition

Paying for Services Not Covered by Medicare Hospice

The charge for room and board while enrolled in hospice at a skilled nursing facility can be handled in a number of ways. The most expensive option is to pay this cost out of pocket. Other options include using secondary insurance, either private or Medicaid (if dual enrolled), to cover eligible costs.

It is important to check with individual insurance policies to learn whether coverage includes room and board.

A person’s original Part A Medicare coverage may also offer coverage for health care services not related to the terminal condition. For example, if a patient receiving hospice care falls and needs surgery for a broken hip, Part A may provide coverage for that part of the care.

Other Hospice Care Options

Facing a terminal illness can be overwhelming, and your healthcare team, along with a Medicare-certified hospice agency, can help you choose the best option for care. If a person and their doctor agree it’s appropriate, hospice care can also be delivered at their home, at the home of a trusted friend or family member, or anywhere else the patient may call home.

Amedisys has been serving patients and their families since 1982 and provides high-quality hospice care to thousands of people each year. To learn more about hospice care and whether it could help you or a loved one, contact a care center near you today.