TRICARE covers hospice care in the United States, District of Columbia and U.S. Territories under the following guidelines:
- The patient, primary physician or authorized family can initiate hospice care.
- Hospice care will only start with a doctor's order.
- The patient must complete an "election statement" and file it with the regional contractor.
Hospice care is not covered in any other overseas areas (outside of U.S. Territories).
Because hospice care emphasizes supportive services, such as pain control and home care, the benefit allows for home health aid and personal comfort items, which are limited under TRICARE's main coverage programs. However, services for an unrelated condition or injury, such as a broken bone or unrelated diabetes, are still covered as a regular TRICARE benefit.
TRICARE does not cover room and board unless the patient is receiving inpatient or respite care. Patients cannot receive other TRICARE services or benefits (curative treatments related to the terminal illness) unless the hospice care is formally revoked. No care for the illness is covered by TRICARE unless the hospice provides or arranges for the care.
Hospice care is provided in three benefit periods, and each benefit period requires prior authorization. The first two periods are each 90 days. The final period comprises an unlimited number of 60-day periods, each of which requires recertification of the terminal illness. If a beneficiary revokes a hospice election, any remaining days in that period are forfeited.
Levels of Care
There are four levels of care within the hospice benefit:
- Continuous home care
- General hospice inpatient care
- Inpatient respite care
- Routine home care
Care within the four levels may include physician services, nursing care, counseling, medical equipment, supplies, medications, medical social services, physical and occupational services, speech and language pathology and hospice short-term acute patient care related to the terminal illness.
Revoking a Hospice Election
To formally revoke the hospice election, the beneficiary must submit a signed, dated statement through the hospice provider. If the beneficiary chooses to revoke hospice, any remaining days in that period are forfeited, but hospice coverage for any election period may be elected at any time.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryClick to closeTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 6/28/2019