After coming to the realization that an affected family member may benefit from the advantages of hospice care, one of the most common questions that follows is how to pay for the services. Hospice care can be a critical support program offered by a team of care workers such as a nurse, doctor, minister, and other individuals who address the spiritual, emotional, and physical needs of a patient.
Without a clear understanding of how patients and families pay for hospice care, family members may put off the conversation entirely and not know that they are keeping a loved one from getting the support that he or she needs. Bear in mind that while a great many people in need of hospice care may qualify for it due to Medicare, most private insurers also cover hospice as well. It is best to first investigate options before closing the door on the important conversation about hospice care. Hospice care is something that can help both the patient and his or her family.
Basics of Hospice
Hospice care provides pain relief and symptom support to a patient who has received a diagnosis of having six or less months to live. After a loved one has been diagnosed with a terminal illness and begins the end of life journey, it can be challenging to initiate the talk about care options. Many family members avoid this conversation entirely because death is a difficult topic, and because of the anxiety and fear surrounding the potential burden of expense. This is why it is important to realize that a loved one may be eligible to complete their end of life journey with dignity and comfort without the pain and anxiety of becoming a financial burden or strain.
Coverage Options for Hospice
There are many different private, federal, and state coverage options, meaning that hospice care is frequently more affordable than family members think, sometimes resulting in little or no cost for the loved-one or the family members. Knowing all of the choices available is strongly recommended, and identifying an experienced hospice care team early on can assist with many of the different questions associated with the transition to hospice care. A doctor may recommend that a patient consider hospice care. The patient themselves may also suggest hospice care when they no longer see the benefits of receiving traditional options. Hospice care does not provide curative treatments addressed for the illness. Rather, it is focused more on providing peace, comfort, and support for symptoms that the patient is coping with at the end of life.
The Medicare Hospice Benefit
Medicare is the name for the national health program for permanent residents or citizens aged 65 years or older. Medicare coverage may also be eligible to assist younger individuals with qualifying disabilities or permanent kidney failure. There are four primary parts to Medicare that can be aligned with various medical needs.
Medicare Part A Insurance
Medicare Part A insurance assists with the cost linked with placement in:
- Hospice care
- Home health services
- Nursing facility care
- Nursing home care
- Hospital care
The majority of individuals will qualify for free Medicare Part A due to a spouse working or themselves working for a minimum of ten years in the U.S. and making payments towards associated Medicare taxes.
Medicare Part B Insurance
Medical insurance provided by Medicare Part B assists with the costs connected with medical equipment, doctor’s visits, and outpatient hospital care, among other services.
Medicare Part C Insurance
Medicare advantage plans fall under the umbrella of Medicare Part C. Medicare advantage plans provide all of the benefits under Medicare Part A and Part B with additional options such as dental, vision, and hearing. Some plans may even provide prescription coverage support.
Medicare Part D Insurance
Medicare Part D refers to prescription drugs specifically. It is a singular program offered by a private plan approved by Medicare. These are often bundled with other plans, and as always, it is wise to evaluate all plan options by reading the fine print when signing up with any of these. This helps to answer difficult questions when it comes time to qualify for these critical support programs.
In the 1980s, the U.S. government started a hospice benefit program with Medicare. The Medicare’s hospice benefit is structure to provide individuals who have received a life limiting illness with a comfortable, peaceful, and dignified journey without the significant financial burden that may be associated with this service if the patient had to pay for it on their own. This is the most common type of payment remitted for hospice services in the United States, making up the payment coverage option for over 85% of patients getting hospice care.
What Patients and Family Members Need to Know About Qualifying for the Medicare Hospice Benefit
In the event that a loved one wants to receive hospice care and financial assistance from the federal government, there are several different criteria that must be met first. These include:
- The patient must already have Medicare Part A coverage
- The person legally designated to speak on the patient’s behalf must have stated their acceptance of palliative care instead of curative measures of the illness
- The primary physician and the medical director for hospice must have certified that the loved one has six months or less to live
- The loved one must have formally chosen to get hospice care with a particular hospice organization
After these initial qualification requirements have been met, the hospice benefits are split up into what is known as benefit periods. The first benefit period is 90 days long, which is followed by a second 90-day benefit. After these two 90-day benefit periods have been used up, there are unlimited 60 day periods following. At the conclusion of each qualifying benefit period, the loved one must meet the criteria again for having a life limiting illness. In the event that a loved one wants to stop care through hospice, they can always elect to stop this coverage at anytime.
Look into Hospice Early
Do not miss out on exploring the hospice option if a loved one has requested it or if a doctor has recommended looking into it. With Medicare covering the vast majority of people receiving support, there is a good chance that a loved one will be able to get the support and care necessary paid for by the federal program.
Discussing options early on gives the best possible window for the loved one to get into hospice sooner rather than later. A rising number of individuals are being placed into hospice care relatively late and are only able to take advantage of the program for a few days–this can be an unnecessary pressure point for both loved ones and their family members.
By investigating hospice care sooner rather than later, a loved one may be able to leave the uncomfortable hospital environment and get support and care directly in their own home. This is the preferred place to have hospice care for the majority of people who are in hospice, but it can also be administered elsewhere if the person wishes to stay in the hospital or is unable to go home for some reason. When elected at the appropriate time, family members can also serve as part of the hospice care team more effectively.
The Medicare coverage for that patient will then go back to the plan in place prior to hospice care. As long as the qualifications are again met for the Medicare hospice benefit, the patient can also reenter the program at any time as well.
After qualifying for the Medicare hospice benefit, some of the benefits received include:
- Medical equipment
- Non-curative prescriptions
- Medical supplies
- Nursing care
- Bereavement counselling
- Short term respite care
- Short term inpatient care
- Social work services
- Occupational, speech, or physical therapies
- Home health aide services
- Nutritional or dietary services
There are certain services that the Medicare hospice benefit does not cover. The Medicare hospice benefit is structured to provide loved ones with an affordable means to end of life care. There are some costs and treatments, however, that are not covered by the hospice benefit program. These include emergency room assistance unrelated to the terminal illness, in-patient care not associated with the terminal illness, curative treatments, care that has not been arranged by the hospice care organization, transportation by ambulance, or room and board costs. There are also some possible out of pocket costs associated with the Medicare hospice benefit. These include:
- Room and board charges
- In-patient Respite Care
- Prescription Drug Cost
Having all of the questions answered upfront can give a great deal of peace of mind to loved ones who are concerned about the costs of hospice.