Who Pays for Hospice and Palliative Care?
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: ‘Traditional' Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.
What hospice services does the Medicare Hospice Benefit cover?
Medicare covers these hospice services and pays nearly all of their costs:
Visits to and services provided by your doctor
Medical equipment (such as wheelchairs or walkers)
Medical supplies (such as bandages and catheters)
Drugs for symptom control and pain relief
Short-term inpatient and respite care
Home health aide and homemaker services
Physical and other therapies
Social work services
Grief support and counseling
What Will I Have to Pay for Hospice Care?
Medicare pays the hospice for your hospice care. You may have to pay:
5% of the Medicare payment amount for respite care: For example, if Medicare pays $100 per day for respite care, you may have to pay $5 per day. You can stay in a Medicare-approved hospital or nursing home up to five days each time you receive respite care.
No more than $5 for each prescription drug and other similar products: The hospice can charge up to $5 for each prescription for drugs or other similar products for pain relief and symptom control.
What services are not covered?
The care that you receive for your terminal illness must be from a hospice. When you choose hospice care:
Medicare won't pay for any of the following:
Treatment to cure your terminal illness.
As a hospice patient, you receive comfort care to help you cope with your illness, not cure it. Comfort care includes drugs for symptom control and pain relief, physical care, counseling, and other hospice services. Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Under the hospice benefit, Medicare will not pay for treatment to cure your illness. You should talk with your doctor if you are thinking about possible ways to treat and cure your illness. As a hospice patient, you always have the right to stop hospice care and receive the ‘Traditional' Medicare coverage you had before choosing hospice.
Care from another hospice.
Once you choose a hospice program and sign the enrollment forms, you must receive hospice services from that hospice program. You cannot receive hospice care from another hospice program, unless you officially change your hospice program. The only time another hospice can care for you is if you are traveling and your hospice program arranges for another hospice to provide short-term care during your trip.
Care from another health care provider that the hospice is supposed to give you.
All care that you receive for your terminal illness must be given by your hospice team. You cannot receive the same type of care from a different provider unless you change your hospice provider.
The cost of room and board in a nursing facility or hospice residential facility.
Room and board in a nursing home/facility or hospice residential home/facility are not covered by the Medicare Hospice Benefit. The cost of residential long-term care is typically paid by the individual, or through long-term care insurance, or Medicaid if the person is financially eligible.
In addition to home care, the Medicare and Medicaid Hospice Benefits do cover short-term stays in a hospital, hospice facility and nursing facility. These short stays include respite care of up to five days, and general inpatient care when a person is admitted for pain or symptom management and is discharged when the pain and/or symptoms are under control.
Adapted from U.S. DEPARTMENT OF HEALTH AND HUMAN SRVICES, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Publication No. CMS 02154. Revised July 2003
What Is The Medicaid Hospice Benefit?
Medicaid is health insurance that helps people who can not afford to pay some or all of their medical bills. Medicaid is available to those individuals that meet the financial eligibility requirements set by their state law. Under Medicaid, like Medicare, there is a Hospice Benefit. The Medicaid Hospice Benefit is an optional benefit that individual States may choose to make available to people in the Medicaid program. 47 States currently have the Medicaid Hospice Benefit.
Please contact the National Hospice and Palliative Care Organization's HelpLine at 800/658.8898 to find out if your state has the Medicaid Hospice Benefit.
The Medicaid Hospice Benefit covers the same services that the Medicare Hospice Benefit covers. However, there may be some differences, so it will be important for you to ask your hospice provider about the services provided under your state's Medicaid Hospice Benefit.
Most private health insurance policies have a hospice benefit that includes some or all of the services provided under the Medicare and Medicaid Hospice Benefits. To find out if your health insurance has a hospice benefit, contact your health insurance representative. If your insurance has a hospice benefit, make sure to ask if the benefit covers all hospice services and what costs you may be asked to pay.
How is Palliative Care Paid For?
In addition to hospice care, there are other end-of-life care services that you may choose to use. Palliative care works much like hospice services, but can be provided to a person at any time during their illness, which is different from hospice's defined set of services.
Currently Medicare and Medicaid do not offer a ‘palliative care' benefit. The palliative care services covered will depend upon your Medicare, Medicaid, or private insurance coverage. It is important for you to ask the palliative care provider how or if the services will be covered and what, if any, costs you will be asked to pay.
Finally, it is important to note that non-profit hospice companies will provide Hospice Care regardless of your ability to pay.
If you have a question that isn't addressed above, email Caring Connections at firstname.lastname@example.org.