How is Hospice Paid For?
- 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,
hospices will work with the person and their family to ensure needed services can be provided.
- More than 90% of hospices in the United States are certified by Medicare. 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.
- 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 patient or family. As a result, the financial burdens usually associated with caring for a terminally ill patient are virtually nonexistent. In addition, most private health plans and Medicaid in 47 States and the District of Columbia cover hospice services.
- Sometimes a terminally ill patient's health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care and won't recertify you at that time. Also, as a hospice patient, 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.
The 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 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.
Hospice care is covered under Medicare Part A (Hospital Insurance). 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 are terminally ill and probably have less than six months to live, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness*, and
- You receive care from a Medicare-approved hospice program.
*Please note: Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness.
Medicare covers these hospice services and pays nearly all of their costs:
- Doctor services
- Nursing care
- Medical equipment (like hospital beds, wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Medications 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
Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person who takes care of you every day, like a family member. Sometimes your caregiver needs someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare- approved facility, such as a hospice residential facility, hospital, or nursing home.
The Medicare Hospice Benefit Does Not Cover the Following:
- Treatment intended to cure your terminal illness.
As a hospice patient, 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 and pain- free as possible. Under the hospice benefit, Medicare won't pay for treatment to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, 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.
Medicare pays the hospice for your hospice care.
You will have to pay:
- No more than $5 for each prescription drug and other similar products: The hospice can charge up to $5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
- 5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $100 per day for inpatient respite care, you may pay $5 per day. You can stay in a Medicare-approved hospital or nursing home up to five days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.
Yes. You should use your Medicare health plan (like the Original Medicare Plan or a Medicare Advantage Plan) to get care for any health problems that aren't related to your terminal illness. You may be able to get this care from your own doctor, who isn't a part of the hospice, or from the hospice doctor. When you use your Medicare health plan, you must pay the deductible and coinsurance amounts or the co- payment.
Resource: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Publication No. CMS 02154. Revised July 2003
