Considering hospice care? Unsure if your insurance will cover it? While the majority of hospice care patients are covered by Medicare and Medicaid, respectively, hospice care is provided by many private insurance companies. However, variations in qualifications and covered benefits exist among private insurers, and therefore it’s always best to check with your insurer to determine what hospice care services are provided under your plan. Read more about what types of services are often covered by private insurance, how you can obtain it, and how a hospice care provider can help.
What Hospice Services Does Private Insurance Cover?
Most private insurance plans model their hospice insurance coverage on the federal Medicare Hospice Benefit Program and cover costs at 100%. However, it’s always important to contact your insurance provider for specific information about what they will cover (and what patients will be responsible for paying), as each policy is slightly different. Generally, insurance will cover the following hospice care services:
- A highly skilled network of doctors, nurses, hospice assistants, social workers, chaplains, bereavement counselors and hospice volunteers.
- Medical devices related to the terminal diagnosis of the patient, including wheelchairs, hospital beds, and walkers.
- Necessary medical supplies including incontinence supplies, catheters, and bandages.
- Medications prescribed by the patient’s doctor to manage their symptoms related to their terminal illness.
- Short-term in-patient care related to the terminal diagnosis of the patient.
- Respite care for up to 5 days for the patient’s family caregivers at home or in an inpatient care facility.
Again, patients are advised to talk to their private insurance provider about what services included as part of their policy to ensure that the aforementioned services are covered, and to be aware of any associated costs.
FAQ: Frequent Private Insurance Hospice Coverage Questions
Are there any out of pocket expenses?
Patients and their families may be required to pay insurance copayments and deductibles, which can vary based on the coverage offered (and their insurance provider). Thus, it’s important to contact your provider to know what out-of-pocket expenses you may be responsible for, so that you know what to expect.
What If I am uninsured or under-insured?
If you have no insurance coverage or are under-insured and can’t afford all the services you need, hospice can provide care on a case-by-case payment plan or (in some cases) completely free. This financial support is generally provided by donations, gifts, grants and other sources of community support. Call your local hospice provider to find out if they are willing to provide care for free or reduced costs.
Am I eligible for hospice care?
While patients who are financially ’eligible’ for hospice care vary depending on their insurance provider, most hospice care in the United States is covered under the Medicare Hospice Benefit guidelines. To be eligible for hospice, which require the following three criteria to be met:
- Patients must be 65 years or older.
- Patients must be diagnosed with a terminal illness.
- Patients must possess certification from their primary doctor or a hospice medical directors confirming they have six months or less to live
Be advised: your insurance company may have its own unique requirements that you must meet before you can begin hospice care. Check with them to ensure you are eligible.
Are there benefits available for U.S. Veterans?
The Veteran’s Health Administration covers hospice care for veterans, and offers similar benefits to those provided by the Medicare Hospice Benefit Program. Veteran hospice care services may also be covered by a variety of other services including HLH through VA (U.S. Department of Veteran Affairs), Tricare, Medicare, Medicaid, and private insurance. If you think you may be eligible, read more about hospice care for veteran’s here, or contact a local hospice care provider for more information.
When can I begin hospice care?
If you are considering hospice care and are eligible for hospice care under your insurance program, now is the time. Hospice care can begin as soon as a formal request is made by your doctor. Shortly after, a hospice program representative will visit you to discuss your options with you and your caregivers, and make the necessary arrangements for your immediate care. This can take no more than two days at the most, and in urgent situations may begin sooner.
Contact Harbor Light Hospice For More Information
For more information about private insurance coverage for hospice care, contact Harbor Light Hospice. We are dedicated to providing all eligible hospice care patients with the comprehensive care they deserve, and will answer all of your hospice care questions and concerns. Let us help you know what to ask your insurance provider regarding the hospice care services (and expenses) you are entitled to, and find out how our compassionate hospice care teams can improve your (or your loved ones) quality of life. Contact us today to get started!