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Who Pays?

 
Patients with a terminal illness do not usually have to pay for hospice care.

More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which many hospices surpass through voluntary, community-based efforts.

The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.

Most commonly, Hospice care costs are covered by Medicare (through the Medicare Hospice Benefit), however, other forms of insurance cover hospice services as well, like Medicaid, most major insurance companies and The Veteran’s Health Administration.

The Hospice Benefit provides for:

  • Physician services
  • Nursing care
  • Medical appliances and supplies
  • Medications for symptom management and pain relief
  • Short-term inpatient and respite care
  • Homemaker and home health aide services
  • Counseling
  • Social work service
  • Spiritual care
  • Volunteer participation
  • Bereavement services

Who is Eligible?
Medicare has three key eligibility criteria:

  • The patient’s doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with a life expectancy of six months or less, if the disease runs its normal course;
  • The patient chooses to receive hospice care rather than curative treatments for their illness; and
  • The patient enrolls in a Medicare-approved hospice program.

Payment for Hospice:
Medicare pays the hospice program a per diem rate that is intended to cover virtually all expenses related to addressing the patient’s terminal illness. Because patients require differing intensities of care during the course of their disease, the Medicare Hospice Benefit affords patients four levels of care to meet their needs: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. Most hospice care is provided at the routine home care level.

The Hospice Benefit rates have increased annually based on the Hospital Market Basket Index. With the advent of costly new drugs and treatments like palliative radiation, the average cost to hospices has risen much faster than the hospice benefit reimbursement rates.

Hospices that are Medicare-certified must offer all services required to palliate the terminal illness, even if the patient is not covered by Medicare and does not have the ability to pay.

Medicare and Medicaid

  • Currently, most hospice patients have their costs covered by Medicare, through the Medicare Hospice Benefit.
  • Medicaid also pays for hospice care in most states. People become eligible for Medicaid when their income and assets are low.
  • Medicaid provides benefits that are very similar to the Medicare Hospice Benefits.

Veterans’ Benefits

  • The Veteran’s Health Administration also covers hospice care. If you think you may be eligible, you can read further information for veteran’s benefits.
  • The Veteran’s Health Administration provides benefits that are very similar to the Medicare Hospice Benefits.

Health Insurance
  • Many private insurance companies provide some coverage for hospice care. Check with your insurer to determine whether hospice care is covered and under what circumstances. Among private insurers, there are variations in qualifications and covered benefits.

Individuals who do not have insurance

  • If you do not have insurance coverage and cannot otherwise afford the service, a hospice may provide care free of charge or on a sliding scale basis.
  • This financial assistance is provided through donations, gifts, grants or other community sources. Call your local hospices to learn if they are able and willing to offer care for free or reduced cost in your case.

Whether a patient is eligible for hospice benefits may vary depending on who is covering the cost of care. Currently, most hospice care in the US is covered by the Medicare Hospice Benefit, which requires:

  • patients to be diagnosed with a terminal illness, and
  • be 65 years or older, and
  • have the patient’s doctor and a hospice medical director certify that the patient has six months or less to live.
  • Many other hospice benefit programs follow these same guidelines set by Medicare.