When someone is faced with serious disease, there are many decisions to make regarding how best to care for them can arise. A common question that most patients and families will consider is, “how is hospice paid for?” While the prospect of organizing end-of-life care may seem daunting, but there are many options for covering the cost of hospice care and there are numerous resources to help patients and families learn about them.
Taking the time to consider all the options can make the situation less stressful and potentially help keep costs to a minimum. In many situations, hospice care is generally covered by Medicare, Medicaid, and most private insurers.
Paying for Hospice – Medicare / Medicaid / Other Options
Hospice care may be for in a variety of different ways. The most widely accessed forms of coverage typically include Medicare, Medicaid, and private insurance, but other options are sometimes available to accommodate military personnel, military retirees, and those who are unable to pay.
Medicare
Medicare is one of the most widely accessed form of coverage for hospice patients. Medicare is a federal health insurance program designed for individuals who are over 65 years of age, younger individuals who have certain long-term disabilities, and individuals who are suffering from End-Stage Renal Disease who require dialysis, or a transplant. Medicare is divided into four different parts:
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
Medicare Coverage for Hospice
If an individual qualifies as a medicare beneficiary, then their hospice care will be covered under the Medicare Hospice Benefit, which is included in Medicare Part A. Medicare coverage does not cancel out other coverage options that a beneficiary may be eligible for. To qualify for the Medicare Hospice Benefit, a patient must meet the following criteria:
- The patient must be eligible for Medicare Part A
- The patient must receive prognosis from a physician that they have six months or less left to live, should the disease continue on its normal progression
- The hospice care will be provided by a Medicare-approved hospice program
Hospice Medicare Pre-Election and Counseling
If certain criteria are met, Medicare permits a physician who is either the medical director or employee of a hospice agency to visit a beneficiary one time and evaluate the beneficiary’s need for care and provide counseling. This is referred to as “Pre-Election Evaluation and Counseling Services.” This visit will include the following:
- An evaluation of an individual’s need for management of pain and other symptoms
- Provide counseling on the hospice and other care options for their consideration
- Provide further guidance on advanced care planning
If an individual would like to receive this service, they must have received a prognosis of six months or less left to live in addition to the following:
- The individual has not made a hospice election
- The individual has not received pre-election hospice services previously
Medicaid
Most states in the U.S. offer hospice coverage under Medicaid. Medicaid is a program that receives both state and federal funding. Medicaid seeks to provide financial assistance with medical costs for individuals who have a more limited income. Generally, hospice benefits under Medicaid are similar to those provided under Medicare. However, it is important to remember that Medicaid coverage can vary from state to state. In most cases, hospice providers are certified by Medicaid from the state that they serve patients in.
Private Insurance
Hospice care is usually covered under most insurance plans issued by employers. Depending on the exact policy, hospice care may also be covered under a private health-insurance policy.
Private Pay and Charity Care
Medicare guidelines state that no individual may be refused hospice support due to an inability to pay for care.If the financial support an individual receives for hospice care proves to be inadequate, hospice providers will work directly with individuals and their families to make sure patients receive the best treatment. It is often the case that a hospice has support staff who is able to answer questions on how patients can receive financial assistance.This type of coverage is normally funded by donations, gifts, grants, and other community support that a provider receives
Choosing to End Hospice Care
If a patient already in hospice care goes into remission or decides that hospice care is no longer needed, the patient can return to the previous Medicare or insurance coverage that was in place before entering hospice care. Patients can choose to stop participating in hospice care at any time.
Understanding Your Options
Considering how to pay for hospice care may seem overwhelming, especially at a time when a family is already dealing with a patient’s terminal illness, but there are resources available to help find the right coverage.
If you are unsure what is covered by the individual’s Medicare plan or insurance, you can visit Medicare.gov/contacts or call 1-800-MEDICARE. You can also contact your State Health Insurance Assistance Program (SHIP) at shiptacenter.org.
