Coverage and cost: who pays?
For over 80% of hospice patients, 100% of the cost of hospice care is paid by Medicare or Medicaid. For patients with private insurance for hospice care, coverage is usually comprehensive with little or no deductible - if you contact us we'd be happy to help you sort this out. For patients or families who prefer to pay for services directly or who do not have other options, hospice care is charged at a per diem rate and can be more affordable than you might think - just call or email us and we'll work with you. Whether your care is covered by Medicare, Medicaid, private insurance or private pay, most of the following information provided by Medicare about their hospice benefit will apply, so it's likely worthwhile reading.
Medicare Hospice Benefit
The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospitalization insurance). Medicare beneficiaries who choose hospice care receive a full scope of medical and support services for their life-limiting circumstance. Hospice care also supports the patient's family and loved ones through a variety of services.
More than 90% of hospices in the United States are certified by Medicare. This benefit covers virtually all aspects of hospice care with little or no out-of-pocket expense from the patient or family. In addition, most private health plans and Medicaid in 47 States and the District of Columbia cover hospice services.
From time to time while on hospice care, a patient’s health may improve or their illness may go into remission. If that happens, your hospice provider may determine that the patient no longer meets Medicare criteria for hospice care and the patient will be discharged from care. Also, the patient or their legal guardian always have the right to terminate hospice care, for any reason. Once an election to stop hospice care has been made, a patient will receive the type of Medicare coverage provided before electing hospice. If a patient is eligible and wishes to re-elect care, re-enrollment in hospice can happen at any time.
What does Medicare cover?
Medicare defines a core set of hospice services which means that hospices are required to provide these designated services to every person they serve:
- Hospice Physician services;
- Hospice Nursing care;
- Medical equipment (like wheel-chairs or special beds);
- Medical supplies (like bandages and catheters);
- Medications for symptom control and pain relief;
- Short-term care in the hospital, including Respite and Inpatient Hospice;
- Social Worker services;
- Grief and Bereavement care for the patient and family.
What doesn't Medicare cover?
Hospice team members will consult with the hospice physician and will inform the patient and family or caregiver which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment and supplies to make the patient as comfortable as possible. Under the hospice benefit, Medicare won’t pay for treatment where the goal is to cure the patient's hospice diagnosis. Patients and families should consult with their doctor if any further intervention or treatment to cure the patient's hospice diagnosis is being considered. A patient always has the right to stop hospice care and receive the “traditional” Medicare coverage provided prior to hospice enrollment.
If you have questions about what's covered and what isn't under the Medicare or Medicaid plans, or if you have private insurance or intend to cover the cost privately, feel free to call us at (817) 265-0151 Monday through Friday, 8 am to 5 pm. Or, if you wish, click on the "Contact" tab at the top of this page or the bold "Click here" below and send us an email. We're here to help.
