Who Pays for Hospice?

The decision to call in hospice care is certainly one that shouldn’t be made lightly, but with all the emotions and general busyness that end-of-life care can bring, figuring out how you or your family are going to pay for it may be the last thing on your mind. However, when the time comes, it is important to know ahead of time how hospice will be paid for so that it doesn’t catch you off guard. While hospice care might be one thing you don’t wish to think about, there is some good news:

Hospice care in the home is generally a lot cheaper than receiving care in hospitals, nursing homes, or some other care facility or institutional setting. The for this is that hospice care uses less high-cost technology in the care it provides, plus family and friends also provide a lot of the care too. In most all states, hospice is paid for by Medicare, Medicaid (in most states), the Department of Veteran Affairs, a lot of private insurance plans, HMOs, and other managed care organizations. What’s more—community contributions, memorial donations, and foundation gifts all help many hospices to provide free services to the patients who are not able to afford payment. However, some programs even charge patients according to their ability to pay.

Now, let’s look at how some different programs cover hospice care:

Medicare Hospice

In order to receive payment from Medicare, either an agency or facility has to be approved by Medicare to provide hospice services. Because of this, you pay nothing for your hospice care, but you might still have some co-payments for any prescriptions you need. In addition, you are required to pay a portion of the bill from inpatient respite care.

To qualify for a hospice benefit from Medicare, a doctor and the hospital medical director (who is a doctor too) have got to see the patient and verify that he or she has less than six months to live as long as the sickness or disease runs its normal course. The hospice benefit will then begin with two 90-day periods each and then an unlimited amount of 60-day periods. Either the doctor or the nurse practitioner is then required to re-certify the patient during a face-to-face visit that must happen before the third election period, and then again before each benefit period afterward. What this means is that the patient has to be seen by his or her doctor as well as the hospice doctor in order to be certified to receive the first 180 days of hospice care. After that, he or she has to be seen again to be re-certified every 60 days for as long as hospice care is required.

The patient will also sign a statement saying that he or she is aware of the illness and understands both it and hospice care and that he or she would like to be admitted to hospice. In doing so, the patient chooses the Medicare hospice benefit for all care relating to the illness. He or she may also receive care for illnesses not related to cancer, and a family member can sign the statement if the patient is unable.

Medicaid Coverage

Many states do have a Medicaid hospice benefit that is patterned after the one provided by Medicare.

Private Insurance

Many private health insurance companies do include hospice care as one of their benefits. Please make sure to ask about your insurance coverage, both for hospice as well as home care.

Private Pay

If you do not have insurance coverage or it is not available to you, or if it does not cover all costs, both the patient and family can hire hospice providers and then pay for any services out of pocket. Some hospice programs can provide services free of charge if a patient or the family has limited or no financial resources.