Hospice care is paid for from a variety of sources. The types of payment coverages available and the services covered are discussed below.
Medicare: The Medicare Hospice Benefit is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive the full scope of medical and support services mentioned in the. ‘What’s Covered Under Hospice Care’ page of this website.
Eighty percent of people who receive hospice care are over the age of 65 and are entitled to the services offered by the Medicare Hospice Benefit. More than 90% of hospices in the United States are certified by Medicare. Medicare-certified hospices are listed on the HospiceDirectory.org website. The Medicare Hospice Benefit covers all care related to the terminal illness (and related illnesses) as determined to be medically necessary by the hospice physician. Medical conditions not related to the terminal illness are covered by the Medicare coverage the patient had before electing the hospice benefit. All Medicare services other than hospice continue under Parts A & B, including those of the patient’s personal physician. Hospice payments do not interfere with any other Medicare payments for other illnesses, diseases, or care.
Original Medicare covers all Medicare-covered services the patient receives while in hospice care, even if they were previously in a Medicare Advantage Plan or other Medicare health plan. If the patient’s plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), the plan will continue to cover these extra services as long as the patient continues to pay the premium.
Who’s Eligible for Medicare Hospice Benefits?
All of the following criteria must be met for a person to receive Medicare hospice benefits:
The patient is eligible for Medicare Part A (hospital insurance).
The patient’s doctor and the hospice medical director certify the patient has a life-limiting illness and, if the disease runs its normal course, death may be expected in six months or less.
The patient signs a statement choosing hospice care instead of routine Medicare-covered benefits related to their life-limiting illness.
The patient receives care from a Medicare-approved hospice program.
Medicaid: In 48 states and the District of Columbia, Medicaid provides coverage for hospice services. In general, Medicaid hospice benefits parallel the Medicare benefit, although there may be some variations in certain states. HospiceDirectory.org provides a listing of Medicaid-certified hospices by state.
Private Insurance: Most insurance plans issued by employers and many managed care plans offer a hospice benefit. In most cases, the coverage is similar to the Medicare benefit although there may be some variations among employers.
Tricare: ‘Tricare’ is the health benefits program for military personnel and retirees. Hospice is a fully covered benefit under Tricare if services are provided by a Medicare-certified hospice. The patient or family should consult with their Health Benefit Advisor or Health Care Finder to locate a qualified hospice agency. Hospices listed in HospiceDirectory.org indicate if they’re Medicare certified.
Private Pay: If insurance coverage is unavailable or insufficient, the hospice social worker or finance advisor can discuss private pay and payment options with the patient or patient’s family.
Charity Care: Under Medicare law, no person may be refused hospice care due to inability to pay. Each hospice provider has a financial specialist on staff to answer questions and provide guidance about receiving financial assistance. Funds may be available from donations, gifts, grants, or other community sources to help cover the cost of care.
Who Pays for Conditions for Which the Patient Was Being Treated Prior to Entering Hospice Care or Which Are Unrelated to the Life-limiting Illness?
Hospice covers the patient’s medical care and there should be no need to go outside of hospice to get care for the life-limiting illness (except in very rare situations). However, the patient must pay the deductible and coinsurance amounts for all Medicare-covered services to treat health problems that aren’t part of their terminal illness and related conditions. They must also continue to pay Medicare premiums, if necessary.