Who Pays for Hospice Care at Home?

Hospice is a program that provides care and support for patients with terminal illnesses. It allows them to enjoy the best quality of life possible and focuses on comfort rather than curing an illness. It differs from medical care because it uses a “whole person” approach that addresses their physical, social, emotional, and spiritual needs. It also offers support to family caregivers.

Hospice care is usually provided in the home, although inpatient services are available for respite care and acute treatment on a short-term basis. Hospice services can also be given to people who are living in long-term care or nursing facilities. It includes services such as physical care, medication, supplies, and equipment for the illness and any related conditions.

How Is Hospice Care At Home Paid For?

In most cases, patients who have terminal illnesses do not pay for hospice care. Below are some of the potential sources of funding for this type of care.

Medicare Or Medicaid

Most hospice patients find that Medicare will cover most or all of their costs through the Medicare Hospice Benefit as long as the hospice provider is Medicare-approved. Finding a qualified provider is not difficult; more than 90 percent of all American hospices have been certified by Medicare. This coverage falls under Medicare Part A, which is the category for hospital insurance.

Patients who are terminally ill and have been given a life expectancy of six months or less or who have otherwise met eligibility requirements and paid their Medicare premiums will qualify for hospice free of charge. However, some patients will have to make a co-pay of no more than $5 for prescription drugs and other symptom-control products that may be needed at home. If inpatient respite care is needed at some point, patients will be responsible for 5 percent of the Medicare-approved amount of such care.

It is important to note, however, that once hospice benefits begin. Medicare will no longer cover any treatment that is intended to cure the terminal illness, including prescription drugs. Any medical condition a patient has that is unrelated to their terminal illness will be covered under the Medicare coverage that was in place prior to activating the hospice benefit.

In most states, Medicaid pays for hospice care for patients whose income and assets are low. The benefits it provides are very similar to those of the Medicare Hospice Benefits.

Medicare covers nearly all of the costs related to hospice services, such as physician and nursing care, pain relief and symptom control medication, equipment such as wheelchairs, physical therapy, nutrition counseling, speech therapy, grief counseling for family members, supplies such as bandages and health aides in the home.

Veteran’s Benefits

Veterans account for around a fourth of all deaths in the U.S., and many hospices are trained to address the type of issues that can arise during this stage for those who have served in the military. For example, it is common for traumatic combat experiences to return to their awareness in their final days. Hospice experts can make this a more peaceful time for these patients.

The Veteran’s Health Administration will cover hospice care for those who meet eligibility requirements. Qualified veterans must be in the final phase of their lives, which typically means they have been given a diagnosis of six months or less to live and are no longer seeking any other type of treatment beyond palliative care.

All enrolled veterans who meet the clinical need for this service are eligible because hospice care is considered a part of the VHA Standard Medical Benefits Package. There are no copays for hospice, regardless of whether it is administered by the VA or an organization that holds a VA contract. It can be provided in the patient’s home, an outpatient clinic, or an inpatient facility.

Health Insurance Coverage

Most private insurance policies offer some degree of hospice care coverage. Patients should check with their provider to determine whether hospice care will be covered and under which circumstances it will be allowed. The qualifications and covered benefits vary by insurer.

Financial Assistance

Hospices also accept private payments from those who do not have insurance but are able to self-pay. Patients who do not have any type of insurance coverage and are unable to afford the cost of hospice services may be able to get care free of charge or for a fee that is based on a sliding scale. This assistance comes from donations, grants, gifts, and community sources.

Most hospices have personnel who specialize in financial support and can answer any questions patients and their families have about paying for their services.

Reach Out To Hospice Care Experts

If you or a loved one is facing the final stage of a serious illness, reach out to the compassionate hospice care experts at Traditions Health to learn more about the support we offer.