UNITED STATES—Hello Toni: I am a critical care nurse. On a daily basis, I advise family members daily who are seeking medical assistance for their elderly parents or spouse during end-of-life issues, especially helping them understand hospice.
Can you explain hospice in simple terms for your Toni Says Medicare column readers? I am sure this will help those who are searching for hospice/medical answers for their frail loved ones. Thanks in advance…Sarah from Houston, TX
Sarah: HOSPICE…is a subject no one wants to discuss with their elderly loved one. But hospice can help a family when a loved one is terminally ill, and the illness takes an emotional toll on the caregiver and family as well as on the patient.
Many wait too long to discuss the benefits of hospice with the patient’s doctor because they believe that this subject is for someone’s last days of life and to help a person die peacefully. They are not aware that hospice can give hope along this journey with education, medication to manage symptoms, support to the patient and family, and counseling services for the patient, family members and caregivers.
Four years ago, my own mother was diagnosed with dementia that qualified her for hospice, and she passed away peacefully. I, Toni King, have experienced everything that hospice offers. Hospice is truly a blessing for those who have a terminally ill loved one.
Healthcare professionals in the hospice system consist of physicians, nurses, social workers, spiritual counselors, certified nursing assistants and volunteers. I would advise those who are navigating hospice to talk with a geriatric case manager or geriatric doctor if you have some concerns or need advice with your loved one’s terminal healthcare issue.
On pages 26-27 of the 2026 Medicare & You handbook, hospice is explained. The handbook discusses what hospice is in Medicare terms and what Medicare covers for hospice under Part A of Medicare. A doctor who orders hospice must certify that the patient is terminally ill, meaning a life expectancy of 6 (six) months or less. The handbook states, “When you agree to hospice care, you agree to comfort care (palliative care) instead of care to cure your terminal illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.”
Hospice can be recertified every 6 months by a hospice medical director or hospice doctor if the patient is still terminally ill. Original Medicare will be billed for hospice care. All medical care for terminal illness is covered by hospice. Original Medicare or Medicare Advantage Plan will pay for health problems that are not related to the terminal illness (co-pays will apply). Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing or personal care home.
Sarah, under “Caregiver relief and support” on page 27 of the handbook, it states that Medicare also covers “inpatient respite care” for the client who is receiving hospice care so that the caregiver, which may be a family member or friend, can rest. The person covered by hospice can stay up to 5 days each time they qualify for respite care. The hospice provider is who arranges respite care. I personally experienced “respite care” for my mother and I was able to have a few days to relax and relieve the stress while she was being cared for in a local nursing home.
Medicare costs under hospice:
• You pay nothing for hospice care (Medicare pays)
• You pay a copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
• You pay 5% percent of the Medicare-approved amount for inpatient respite care.
• Medicare covers up to 5 days for inpatient respite care in a Medicare-approved facility so that the caregiver can have a time of rest.
Email your hospice and Medicare questions to info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.
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Toni King is an author and columnist on Medicare, Social Security, and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.
