HOSPICE CARE

What Medicare Hospice Covers And What It Does Not In Georgia

Summary: When you are caring for someone with a serious illness, understanding what Medicare covers can bring real relief. This guide explains the Medicare hospice benefit in clear terms, what is and is not included, and simple steps to start services in Georgia.

Medicare Hospice Benefit 

Medicare hospice is a package of services designed to keep your loved one comfortable at home or in a facility. The focus shifts from cure to comfort. A physician certifies a life expectancy of about six months if the disease follows its usual course. You can keep your personal doctor while the hospice team manages day-to-day comfort and coordinates care.

What Medicare Hospice Covers

You receive coordinated support from an interdisciplinary team with most costs included. Coverage applies to care that relates to the terminal illness and conditions that are linked to it.

Services typically covered:

• Nursing care for symptom management, medication adjustments, and teaching.
• Hospice physician oversight and collaboration with your personal doctor.
• Medications related to the terminal illness and comfort, often delivered to your home.
• Durable medical equipment such as a hospital bed, oxygen, wheelchair, bedside commode, or suction.
• Medical supplies like dressings, gloves, incontinence products, and wound care items.
• Certified nursing assistant visits for personal care, bathing, grooming, and skin care.
• Social work support for planning, resources, and caregiver guidance.
• Spiritual care that respects your beliefs and preferences.
• Short-term inpatient care when symptoms cannot be managed at home.
• Respite care to relieve family caregivers for a short stay in a Medicare-approved facility.
• Bereavement support for the family after a death.

You can receive hospice care wherever you live. That can be a private home, assisted living community, or nursing facility. If you live in a facility, hospice works with the staff to coordinate comfort care.

What Medicare Hospice Does Not Cover

Medicare hospice is generous, but there are boundaries. Knowing them helps you plan ahead.

Items and services not typically covered:

• Room and board in assisted living or nursing facilities. The facility stay is separate from hospice.
• Curative treatments that try to cure the illness rather than provide comfort.
• Medications and services not related to the terminal illness or conditions linked to it.
• Emergency department visits and hospitalizations that are unrelated to the hospice diagnosis unless arranged with hospice.
• Private duty or 24-hour in-home caregivers. Hospice visits are intermittent with 24 or 7 on-call support, but continuous bedside care is not routine unless there is a brief crisis that qualifies for continuous home care.

If a treatment is not covered because it is curative, you can choose to revoke hospice and pursue that treatment. You may return to hospice later if appropriate.

Costs, Copays, and How Billing Works in Georgia

For most families, hospice care under Medicare Part A has little or no out-of-pocket cost. You may have a small copay per prescription for outpatient comfort medications and a small coinsurance for respite or inpatient stays. The hospice agency manages and bills most covered services directly, which simplifies the paperwork for you. If you have Medicaid or a Medicare Advantage plan in Georgia, hospice is still covered under the Medicare hospice benefit. Your plan or Medicaid may help with costs that Medicare does not pay.

If you live in a nursing facility or assisted living, your room and board are not part of the hospice benefit. Those charges are handled through private pay, long-term care insurance, Medicaid, or the facility’s own policies.

Covered vs Not Covered at a Glance

Covered when related to the terminal illness

• Comfort medications
• Equipment and supplies
• Nurse, aide, social work, chaplain visits
• On-call support 24 or 7
• Inpatient care for acute symptom control
• Respite care for caregiver relief

Not covered

• Room and board in a facility
• Curative or disease-directed treatments
• Around-the-clock private caregiving at home
• Unrelated medications or services

Respite and Inpatient Care Explained

Respite care provides a short break for family caregivers, usually up to several days, in a Medicare-approved facility. Hospice arranges the stay and continues coordinating care.

General inpatient care is used when symptoms like severe pain, shortness of breath, or agitation cannot be safely managed at home. The goal is rapid stabilization so you can return home as soon as you are comfortable.

Real-world Scenarios Families Ask About

• Hospital bed and oxygen: If these are needed for comfort, they are typically covered and delivered to your home.
• Antibiotics: Covered when they are used for comfort, such as treating a painful infection that affects quality of life.
• Cancer treatments: If a treatment aims to cure or prolong life, it is usually not covered. Treatments used to relieve symptoms, such as palliative radiation for pain, may be covered.
• Dialysis or transfusions: Usually not covered as routine care under hospice. If used to relieve symptoms and clearly part of your comfort plan, the hospice physician will review on a case-by-case basis.
• Care in assisted living: Hospice services are covered, but the facility’s rent and fees are not.

Your hospice team will explain coverage before services begin and whenever needs change. You will know what is included, who is providing it, and how to reach help after hours.

Starting Hospice in Georgia: Simple Steps

1. Talk with your physician about recent changes such as more ER visits, weight loss, or uncontrolled symptoms.
2. Request a hospice evaluation. A hospice clinician will review the medical history and current needs.
3. Elect the Medicare hospice benefit. You or your legal representative sign a form that shifts care to comfort. You can change your mind later.
4. Set up equipment and medications. Delivery is coordinated to your home.
5. Meet your care team and confirm your plan for visits, supplies, and after-hours support.

Frequently Asked Questions

Can you keep your regular doctor?
Yes. Your personal physician can stay involved while the hospice medical director oversees comfort-focused care.

Can you leave hospice if you improve?
Yes. You can revoke hospice at any time and later return if needed.

What if your loved one lives longer than six months?
Hospice can continue with recertification as long as eligibility criteria are met.

Does hospice provide 24-hour caregivers at home?
Routine hospice visits are scheduled, and there is phone support at all times. If symptoms become severe, continuous home care or inpatient care may be provided for a short period.

Are all medications covered?
Medications related to the terminal illness and comfort are covered. Drugs unrelated to the terminal illness may be billed to your regular pharmacy benefit.

Medicare Hospice Coverage Questions? Talk With Our Care Team

If you are unsure what Medicare will cover for your family, we can walk through it together and make a clear plan. Call (404) 921-3341 to speak with our care team now. You can also reach us through Services or Contact.