Medicare’s hospice benefit should cover any prescription drugs you need for pain and symptom management related to your terminal condition.
- You pay a $5 copayment for outpatient pain and symptom management drugs.
- You pay nothing for drugs you receive as an inpatient during a short-term hospital or skilled nursing facility (SNF) stay.
Be aware that the hospice benefit will not cover medications that are not related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to your terminal condition, but your plan’s coverage rules and cost-sharing will apply.
After you elect hospice, Medicare assumes that medications prescribed to treat symptoms of pain, nausea, constipation, and/or anxiety are related to your terminal condition and should be covered by your hospice provider, not your Part D plan. If you do not need these kinds of drugs to treat your terminal condition—but do need them to treat other conditions—ask your hospice provider to send information to your Part D plan indicating the prescriptions are unrelated to your terminal condition before you get them filled. After receiving this information, your Part D plan must cover the medication.
Note: If you are denied at the pharmacy counter for anti-nausea, anti-anxiety, pain, or laxative medication unrelated to your terminal condition, you should receive a Medicare Prescription Drug Coverage and Your Rights notice. Contact your plan and file an exception request. Your plan must contact your hospice provider to confirm that the medication is unrelated to hospice. Be sure to check with your hospice provider that the plan received this information. Afterwards, your plan must provide coverage within three days or within 24 hours if waiting longer could put your health at risk. If you need your medication sooner, you can ask your hospice provider to cover a temporary supply under the hospice benefit.