repisodic Blog

Hospice and end of life decisions are among the most difficult to make, and figuring out finances through such an emotional process can add to those difficulties.  Fortunately, the majority of hospice costs are covered by most health insurance programs.  This article provides a brief overview of insurance coverage for hospice.

Most hospice care in the U.S. is provided by the Medicare Hospice Benefit.  To qualify for this benefit, a patient must have Medicare Part A insurance and:

• The patient’s hospice doctor and regular doctor or nurse practitioner (if they have one) certify that patient is terminally ill and expected to live 6 months or less
• Patient accepts palliative care (for comfort) instead of care to cure illness
• Patient signs a statement choosing hospice care instead of other Medicare-covered treatments for patient’s terminal illness and related conditions.

The Medicare Hospice Benefit includes medical services such as pain relief as well as support services to the patient and their family. Medicare will pay the hospice provider for the care – there is no deductible.  Patients can also get a one-time only hospice consultation with a hospice medical director or doctor to discuss care options and management of pain and symptoms.  This one-time consultation is available even if a patient decides not to get hospice care. Once the hospice benefit starts, Medicare will cover everything a patient needs related to their terminal illness as long as the care comes from a Medicare-approved hospice provider. Hospice care is usually given in the patient’s home, but it also may be covered in a hospice inpatient facility. Depending on the patient’s condition, hospice services covered under insurance could include:

• 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 patient and family
• Short-term inpatient care (for pain and symptom management)
• Short-term respite care
• Any other Medicare-covered services needed to manage the terminal illness and related conditions, as recommended by the hospice team

Many private insurance companies also provide coverage for hospice care. There are variations in qualifications and covered benefits with private insurers, but the majority of these plans and benefits will be similar to the Medicare Hospice Benefit as described above. It is best to check with your insurer to determine whether hospice care is covered and under what circumstances.

If you do not have insurance coverage and cannot otherwise afford the service, a hospice may provide care at a subsidized rate or free of charge.  There are many community resources and agencies where financial assistance is provided through donations, gifts or grants.

No matter your situation, we can help you find the hospice provider that best meets yours and your family needs.  Learn more about hospice care.