How is Hospice Care Paid For?
How is Hospice Care Paid For?
Hospice care is typically covered by Medicare, Medicaid, and most private insurance plans. Medicare Part A covers hospice care if the patient meets certain conditions, including having a terminal illness with a life expectancy of six months or less if the illness runs its normal course. Medicaid also covers hospice care, though coverage can vary by state. Private insurance plans often offer hospice benefits as well, but coverage specifics can vary, so it's important to check with the insurance provider.
Hospice care can also be paid for out-of-pocket if the patient or family chooses to do so. Some hospice providers offer financial assistance or sliding scale fees based on income for those who qualify. Additionally, nonprofit organizations and charitable foundations may provide grants or financial assistance for hospice care.
Medicare Hospice Benefits
You can get Medicare hospice benefits when you meet ALL of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance),
- You get care from a Medicare-approved hospice program.
- Your doctor and the hospice medical director certify that you are terminally ill and have 6 months or less to live if your illness runs its normal course. Even if you live longer than 6 months, you can get hospice care as long as your doctor recertifies that you are terminally ill.
- You sign a statement choosing Hospice care instead of other Medicare-covered benefits to treat your terminal illness.
What Medicare covers and What we provide?
MEDICARE will cover the hospice care you get for your terminal illness, but it must be from a Medicare-approved hospice provider.
Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.
Medicare and Medicaid/MediCal and most private insurance plans covers the following hospice services for your terminal illness and related conditions:
- Doctor services
- Nursing care
- Medical equipment such as wheelchair, walker, oxygen concentrator
- Medical supplies such as bandages, catheters, oxygen tubings
- Drugs for symptom control or pain relief, may need to pay a small copay
- Hospice aide and homemaker services
- Physical, occupational therapy and speech-language therapy
- Social worker services
- Dietary counseling services
- Grief and loss counseling for you and your family Short-term inpatient care (for pain and symptom management)
What Medicare won’t cover?
- Treatment intended to cure your terminal illness. As a hospice patient, you always have the right to stop hospice care at any time.
- Prescription drugs to cure your illness rather than for symptom control or pain relief.
- Care from any hospice provider that was not set up by the hospice team.
- Room and board. Medicare does not cover room and board if you get hospice care in your home or if you live in a nursing home or hospice residential facility. However, if the hospice team determines that you need short-term inpatient respite care services that they arrange, your stay in the facility is covered.
- Care in an emergency room, inpatient facility care or ambulance transportation, unless it is either arranged by your hospice medical team or is related to your terminal illness.
- Care in an emergency room, inpatient facility care or ambulance transportation, unless it is either arranged by your hospice medical team or is related to your terminal illness.
NOTE: Contact your medical hospice team before you get any of these services, or you might have to pay the entire cost
We’d love to speak with you
Have questions about care, or ready to start care?
Talk to a nurse at your convenience.