PAYING FOR HOSPICE
Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, hospice will work with the person and their family to ensure needed services can be provided.
Medicare Hospice Benefit
The Medicare Hospice Benefit is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting illness. Hospice care also support the family and loved ones of the person through a variety of services.
More than 90% of hospices in the United States are certified by Medicare. Eighty percent of people who use hospice care are over the age of 65, and are entitled to the services offered by the Medicare Hospice Benefit. This benefit covers all of the care related to the terminal illness (and related illness) that is determined medically necessary by the hospice physician. If there is a medical condition that is not related to the terminal illness or related illness, the Medicare coverage you had before electing the hospice benefit will cover these illnesses.
In addition, most private health plans and Medicaid in 48 States and the District of Columbia cover hospice services.
Sometimes a person’s health improves or their illness goes into remission. If that happens, the hospice physician may feel that you no longer need hospice care. If this happens, you will be discharged from hospice and return to the care and the Medicare coverage you had before electing the hospice benefit.
Also, you always have the right to stop receiving hospice care at any time and for any reason. If you stop your hospice care, you will receive the type of Medicare coverage that you had before electing hospice. If you are eligible, you can go back to hospice care at any time in the future.
Who is Eligible for Medicare Hospice Benefits?
You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your illness*, and
- You receive care from a Medicare-approved hospice program.
*Medicare will still pay for covered benefits for any health needs that aren’t related to your life-limiting illness or related illnesses.
What Does Medicare Cover?
Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the persons insurance.
Medicare covers these hospice services and pays nearly all of their costs:
- Doctor services
- Nursing care
- Home health aide and homemaker services
- Social work services
- Therapy services (Physical, occupational and speech therapy as determinded medically necessary by hospice physician)
- Dietary counseling
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control and pain relief
- Short-term care in the hospital or skilled nursing facility for pain and symptom crisis management
- Inpatient respite for caregiver relief
- Short-term hourly care in the home for a pain and symptom crisis management
- Grief support to help you and your family during and after hospice services
You will only have to pay part of the cost for outpatient drugs and inpatient respite care.
The Medicare Hospice Benefit Does Not Cover the Following
- Treatment intended to cure your illness.
You will receive comfort care to help manage symptoms related to your terminal illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services.
- Medications not directly related to your hospice illness or related illnesses are not covered under the Medicare Hospice Benefit.
Hospice team members will consult with the hospice physician and will tell you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. You always have the right to stop at any time to seek curative care.
Care from Another provider When You Elect Your Hospice Benefit.
All care that you receive for your terminal illness or related illnesses must be approved and provided by your hospice team. If you receive care for your terminal illness or related illnesses without hospice approval, you could be laible for the cost.
Nursing Home Room and Board
Room and board are not covered by the Medicare Hospice Benefit. You may receive hospice services wherever you live, even in a nursing home. However, the Medicare Hospice Benefit does not pay for nursing home room and board. The cost for room and board would be an out of pocket expense. If you are eligible for Medicaid, Medicaid will cover room and board charges.
Hospice care provided by the hospice team in the home is intermittent or visit based. You will receive visits by the hospice team based on you and your family’s needs. Hourly care is not covered under the Medicare Hospice Benefit. If hourly care is a necessity, you will need to pay out of pocket for this care or explore another care environment such as a nursing home which offers 24/7 care