Hospice Care: Who Pays and What is Covered?

While no one wants to think about the end of their life, it’s essential to plan ahead and think about how you want to spend your last days. Hospice care provides individuals and their families with the resources and support they need to make the final stages of life as comfortable and pain-free as possible. If you’re a Baby Boomer or have an aging loved one, it’s essential to understand what hospice care is, who it helps, and how to access this essential service.

What is Hospice Care and Who Does it Help?

Hospice care is a specialized service that focuses on providing physical, emotional, and spiritual support to individuals nearing the end of their life. It is not curative, i.e., it does not focus on curing or treating the underlying illness. Instead, the primary goal of hospice care is to ensure that the patient enjoys a high quality of life and is free from pain and discomfort. Hospice care can help individuals with terminal illnesses, including cancer, ALS, heart disease, and dementia. Providing end of life care can be stressful and emotional. Hospice care lessens the burden and stress of this time by ensuring the patient receives their physical, emotional, and comfort needs. While the patient is the primary focus, hospice teams fulfill emotional needs through counseling services that are experienced during loss and grief for family members and other loved ones.

Qualifying for Hospice Care – Eligibility Requirements

To be eligible for hospice care, two physicians must certify that an individual has a life expectancy of six months or less. The prognosis must be based on the disease’s normal course instead of any aggressive treatments that the patient may be undergoing. Hospice care can be provided at home, in a hospital, a nursing home, or a dedicated hospice facility. Certain criteria must be met to ensure safety and proper care. Because the goal of hospice care is comfort and best health possible, but not treatment of being cured, the specific eligible requirements are dependent on life expectancy, prognosis, and symptoms which are necessary to ensure hospice care is the right fit for the patient.

Cost of Hospice Care at Home

In-home hospice care is the most cost-effective option for individuals and their families because it provides care in the comfort of their home without the need for costly hospital stays. The cost of in-home hospice care varies depending on the location, agency, and level of care required. Categorization of the levels of care can vary and depend on length of care and intensity (medicaid.gov explains these levels further). Most hospice agencies work with Medicare, Medicaid, and private insurance providers to cover hospice care expenses, which significantly reduces out of pocket expenses.

Who Pays for Hospice Care – Medicare, Medicaid, Private Insurance or Out-of-Pocket

Hospice care can be expensive, and many families may worry about how they will pay for it. Fortunately, several options exist to ensure that individuals receive the care they need. Medicare pays for the majority of hospice care costs, including services such as nursing care, medication, equipment, and supplies. Medicaid also covers hospice care and provides additional benefits for those who qualify. Private insurance can also cover hospice care, and many hospice agencies offer financial assistance to those who cannot afford to pay for hospice care out of pocket.

How Does Medicare Cover Hospice Care?

Medicare covers hospice care via Part A, which includes payment for routine home care, inpatient respite care, continuous home care, and general inpatient care. Medicare also covers medication used to relieve pain and symptoms associated with a terminal illness. Medicare beneficiaries may not be required to pay copayments or deductibles for hospice care, and they can continue to seek care from their primary physician.

What are Costs that Medicare Won’t Cover?

According to medicare.gov, once a hospice plan has started, Medicare will not cover any costs related to treatment or cure of any terminal disease or illness. Subsequently, Medicare will not cover drugs prescribed to cure the patient’s illness. Remember that patients have the right to seek treatment and end hospice care at any time. Once you choose a hospice agency, Medicare will only cover costs for the that hospice team, meaning you cannot receive care from another hospice agency unless you change your hospice provider. But your primary physician is still able to supervise your hospice care. Lastly, Medicare does not cover room and board costs, whether you are staying in your own home or any other facility. The only exception to this is if your hospice team determines a short-term inpatient stay at a facility is necessary then Medicare will cover your stay.

Choosing the Best Agency to Provide Hospice Care

Choosing the right hospice agency can be difficult, but it is essential to ensure that your loved one receives the best care possible. When selecting an agency, you should consider the agency’s reputation, experience, and availability. It is also important to assess the agency’s level of compassion and support for both the patient and their family.

As you or your loved one advances in age, it’s essential to have a plan in place for end-of-life care. Hospice care provides individuals with a terminal illness with the support, pain relief, and comfort they need to live their last days with dignity and grace. By understanding what hospice care is, who it helps, and how it is paid for, you can make informed decisions and ensure that your loved ones receive the best care possible. Remember that hospice care is a team effort, and choosing the right hospice agency is critical in making the final stages of life as comfortable as possible.

We understand this time can be a difficult one, but we hope that we bring some relief with our care and support. Let us ease your mind and help you feel confident in your discussion to explore hospice care options. Give Centric Home Health and Hospice a call at 1.855.942.3687 for more information because we give you the care you deserve!