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Who Pays For Hospice?

It’s hard enough facing the fact that your aging or terminally ill loved one will be entering hospice shortly, but add the stress of determining who will pay for it all, and it’s understandable why you would feel so overwhelmed. The question of who pays for hospice can become vitally important especially when you’re already bogged down with medical bills from previous treatment. There are a number of ways that hospice can be paid for:

  • Medicare
  • Medicaid
  • Senior HMOs
  • Regular HMOs
  • Private insurance
  • Veteran’s Health Administration

Once in hospice, the patient’s medications, medical equipment and supplies related to their life-threatening disease will be covered.

Breaking it Down

Medicare is one of the most common methods of paying for hospice, covered by the Medicare Hospice Benefit under Medicare Part A. Medicare beneficiaries will receive comprehensive medical and support services for their illness, plus their families will get the support they need to get through this difficult time. More than 90% of hospices in the United States are certified by Medicare, with 80 percent of people in hospice being over age 65. Here are just a few things Medicare will cover:

  • Doctor services
  • Nursing care
  • Home health aide and homemaker services
  • Social work
  • Therapy services
  • Dietary counseling
  • Medical equipment and supplies
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital or skilled nursing facility
  • Inpatient respite for caregiver relief
  • Short-term hourly care in the home
  • Grief support

Medicaid is another option in most states, with eligibility for this plan being a possibility when a patient’s income and assets are very low. The Hospice benefit is an optional state plan service that includes many services for terminally ill individuals, including nursing, medical social services, physician services, counseling services, short-term inpatient care, speech-language pathology services, medical appliances and supplies, home health aide and homemaker services, physical therapy, and occupational therapy, says Medicaid.

Veterans’ benefits can also cover hospice care, with benefits similar to Medicare Hospice Benefits. This is offered only to qualified veterans who are in the final phase of their lives, backed by a multi-disciplinary team approach that helps veterans live fully until they die, according to the VA.

Private health insurance companies also cover for hospice care, but you’ll have to check with the individual’s insurer to determine if this is true. There are often varying guidelines and qualifications when it comes to what’s covered and what’s not.

Individuals without insurance have options too. In the event your family cannot pay for hospice, the hospice care center may provide free care or reduce their fee on a sliding scale in order to admit your loved one. Not all do this, though, so it’s important to check. Such financial assistance is often made possible through grants, donations, memorial gifts, foundation gifts and community resources.

Coverage and Care

The bottom line is, whether you qualify for coverage or not often depends on who is providing the care. Most hospice care offers coverage under the Medicare Hospice Benefit, which requires that the patient has a terminal illness and is diagnosed with said illness by a doctor. The patient must also be over the age of 65, with a prognosis of less than six months to live. According to Medicare, you are eligible for hospice care if:

  • The hospice doctor and regular doctor certify that you’re terminally ill with a life expectancy of 6 months or less.
  • The patient accepts palliative care to keep them comfortable rather than care to cure the illness.
  • The patient signs a statement choosing hospice care instead of other Medicare-covered treatments.

The type of care you opt for your loved one is a very personal decision. Typically, people choose home care but there is inpatient care available in many cases. Whatever the case, your hospice team coordinates and supervises all care 7 days a week, 24 hours a day, according to American Cancer Society. In general, home hospice care costs less than care offered within nursing homes, hospitals, or other institutional settings. Why? With in-home care, less high-tech costs are involved. In addition, round the clock nursing staff isn’t always needed, as family and friends often take shifts to provide care.

Contact Pathways Home Health Hospice

For more answers to your questions regarding paying for hospice, please call Pathways Home Health and Hospice at 888-755-7855.