Paying for Hospice
Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, hospice will work with the person and their family to ensure needed services can be provided.
Medicare Hospice Benefit
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 medical and support services for their life-limiting illness. Hospice care also supports the family and loved ones of the person through a variety of services.
More than 90% of hospices in the United States and Utah are certified by Medicare. Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the person or family. In addition, most private health plans and Medicaid in 47 States and the District of Columbia cover hospice services.
Sometimes a person’s health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care. Also, you always have the right to stop getting hospice care, for any reason. If you stop your hospice care, you will receive the type of Medicare coverage that you had before electing hospice. If you are eligible, you can go back to hospice care at any time.
Who is Eligible for Medicare Hospice Benefits?
You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less to live, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your illness*, and
- You receive care from a Medicare-approved hospice program.
*Medicare will still pay for covered benefits for any health needs that aren’t related to your life-limiting illness.
What Does Medicare Cover?
Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the persons insurance.
Medicare covers these hospice services and pays nearly all of their costs:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control and pain relief
- Short-term care in the hospital, including respite and inpatient for pain and symptom management
- Home health aide and homemaker services
- Physical and occupational therapy
- Speech therapy
- Social work services
- Dietary counseling
- Grief support to help you and your family
You will only have to pay part of the cost for outpatient drugs and inpatient respite care.
The Medicare Hospice Benefit Does Not Cover the Following
Treatment intended to cure your illness.
You will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services.
Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit.
Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. You always have the right to stop getting hospice care and receive the “traditional” Medicare coverage you had before electing hospice.
Care from another provider that is the same care that you are getting from your hospice.
All care that you receive for your illness must be given by your hospice team. You can’t get the same type of care from a different provider unless you change your hospice provider.
Nursing Home Room and Board
Room and board aren’t covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.
Hospice patients have the right to:
- receive care of the highest quality;
- have relationships with hospice organizations that are based on ethical standards of conduct, honesty, dignity, and respect;
- in general, be admitted by a hospice organization only if it is assured that all necessary palliative and supportive services will be provided to promote the physical, psychological, social, and spiritual well-being of the dying patient. However, an organization with less than optimal resources may admit the patient if a more appropriate hospice organization is not available, but only after fully informing the client of its limitations and the lack of suitable alternative arrangements;
- be notified in writing of their rights and obligations before their hospice care begins. Consistent with state laws, the patient’s family or guardian may exercise the patient’s rights when the patient is unable to do so. Hospice organizations have an obligation to protect and promote the rights of their patients;
- be notified in writing of the care the hospice organization will furnish, the types of caregivers who will furnish the care, and the frequency of the services that are proposed to be furnished;
- be advised of any change in the plan of care before the change is made;
- participate in the planning of the care and in planning changes in the care, and to be advised that they have the right to do so;
- refuse services and to be advised of the consequences of refusing care;
- request a change in caregiver without fear of reprisal or discrimination;
- confidentiality with regard to information about their health, social, and financial circumstances and about what takes place in the home;
- expect the hospice organization to release information only as consistent with its internal policy, required by law, or authorized by the client;
- be informed of the extent to which payment may be expected from Medicare, Medicaid, or any other payor known to the hospice organization;
- be informed of any charges that will not be covered by Medicare, and the charges for which he or she may be liable;
- receive this information orally and in writing within 15 working days of the date the hospice organization becomes aware of any changes in charges;
- have access, on request, to all bills for service the patient has received regardless of whether they are paid out of pocket or by another party;
- be informed of the hospice’s ownership status and its affiliation with any entities to whom the patient is referred;
- be informed of the procedure they can follow to lodge complaints with the hospice organization about the care that is, or fails to be, furnished, and regarding a lack of respect for property;
- know about the disposition of such complaints;
- voice grievances without fear of discrimination or reprisal for having done so; and
- be told what to do in the case of an emergency.