How is Hospice Paid For?

Facing a terminal illness brings with it many concerns. Paying for end-of-life care shouldn’t be one of them.

How do you pay for hospice care?

If proper criteria is met, hospice care is paid for through Medicare and Medicaid. For those not eligible for Medicare or Medicaid, payment for hospice can come from private insurance or an HMO, since these also include a hospice benefit.

Who pays for hospice care at home?

The Medicare Hospice Benefit covers end-of-life services related to a patient’s terminal diagnosis in whatever setting the patient calls home, whether that’s a traditional residence, an assisted living facility, or nursing home. Wherever hospice occurs, all services related to the terminal diagnosis are covered up to 100% by Medicare Part A.

If the patient’s symptoms cannot be managed by the routine level of hospice care, additional levels of service, such as 24/7 continuous care or inpatient hospice care, will also be financed through Medicare Part A at no additional expense to the patient or family.

Does Medicare pay for hospice in a skilled nursing facility?

Yes, hospice services provided in a nursing facility are covered by Medicare. In a nursing home setting, hospice helps patients, families, and nursing home staff by providing end-of-life resources and support. The Medicare Hospice Benefit covers services, medications, supplies and equipment that are related to life-limiting illness. It does not, however, cover expenses associated with room and board. These skilled nursing facility room-and-board expenses are often covered by Medicaid when the patient meets the state’s financial eligibility requirements.

Medicare Hospice Benefit

Hospice Care is available for all Medicare beneficiaries who meet the following criteria:

Hospice is available to patients with a terminal diagnosis and life expectancy of six months or less, as determined by the patient's doctor and a hospice medical director. The patient or the family must be aware of the prognosis and decide on comfort care rather than curative treatment for the terminal condition.

Determining a prognosis of six months or less can be challenging. Awareness of decline requires understanding a patient's condition over time. That's why primary care doctors are essential for determining eligibility.

The second criteria for hospice eligibility is an assessment by a hospice medical director or a nurse with specialized hospice training.

Services covered under Hospice Benefit

An interdisciplinary team of hospice professionals
Home medical equipment
Medication
Respite care
Continuous care
Inpatient care
Routine home care
Bereavement support

*For those not eligible for Medicare or Medicaid, payment for hospice can come from private insurance or an HMO, since these also include a hospice benefit.

What Medicare covers

You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and managing your pain and symptoms. You can get this one-time consultation even if you decide not to get hospice care.

Once your hospice benefit starts, original Medicare will cover everything you need related to your terminal illness, but the care you get must be from a Medicare-approved hospice provider.

Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:

Doctor services
Nursing care
Medical equipment (like wheelchairs or walkers)
Medical supplies (like bandages and catheters)
Prescription drugs
Hospice aide and homemaker services
Physical and occupational therapy
Speech-language pathology services
Social worker services
Dietary counseling
Grief and loss counseling for you and your family
Short-term inpatient care (for pain and symptom management)
Short-term respite care
Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

For more information regarding Medicare Coverage visit https://www.medicare.gov