Who Pays for Hospice Care?
The costs of care for a terminal illness can add up quickly. For families, especially, the financial stress combined with the emotional stress can take its toll. Thankfully, options are available when it comes to who pays for hospice care. The most common of which is Medicare, which is available to most patients.
What is the Medicare Hospice Benefit?
The Medicare Hospice Benefit is part of Medicare Part A and is specifically designed to pay for hospice care.
Qualifying for Medicare Part A
Individuals eligible for this portion of Medicare must 65 years or older. In addition, the individual or their spouse must have worked and paid Medicare taxes for at least 10 years.
A person can still qualify for Medicare if they are under the required age. However, this is only if they receive Social Security benefits or benefits from the Railroad Retirement Board.
Requirements for the Medicare Hospice Benefit
Medicare pays for hospice care if patients meet its eligibility requirements.
- Life expectancy must be less than six months.
- The patient ends all curative treatments.
If a patient lives longer than six months, they may still be eligible for the benefit if their doctor still declares them terminally ill. Additionally, if an individual decides to pursue curative treatment, they are free to do so. They will just no longer receive coverage provided by the benefit.
To receive their hospice benefit, Medicare requires all eligible patients pay their monthly Medicare Part A and Medicare Part B premiums. In addition, the benefit involves a copayment of up to $5 per prescription for medication necessary for pain relieve or symptom management. The patient also pays 5 percent of costs associated for inpatient respite care.
What Does Medicare Cover?
When patients choose a Medicare-certified hospice organization, most care costs are covered. These include the following:
- Physicians, nurses and other medical staff necessary for care
- Medications used to control symptoms or alleviate pain
- Any necessary medical equipment such as a wheelchair, hospital bed or ventilator
- Social workers
- Respite care for primary caregiver
- Speech, occupational or physical therapy
- Dietician services
- Grief counseling
- Anything else a patient may need to keep them comfortable and maintain a good quality of life
Items Not Covered by Medicare
Not all costs associated with hospice care will be covered by the Medicare hospice benefit. For example, Medicare will not pay for medications, procedures or treatments aimed at curing a patient’s illness. The benefit also does not cover costs for room and board. Most hospice patients live in their own home or the home of a family member. However, for those living in a nursing home or assisted living facility, they are responsible for paying any housing costs and fees.
Medicare excludes emergency services from its covered costs as well, specifically if the reason for emergency care is caused by something other than their previously diagnosed illness.
Who Pays for Hospice Care Costs Not Covered By Medicare?
So, who pays for hospice care costs that are not included in the Medicare hospice benefit? The Veteran’s Health Administration as well as private insurance companies offer coverage for qualifying patients. In addition, hospice organizations, like Family Hospice, assist patients and families who struggle to afford aspects of care.
As a not-for-profit, financial assistance through Family Hospice is made possible through donations made by the organization’s supporters. These donations not only help those in need, but they also allow for the continuation of programs and initiatives that help families through everything from filing paperwork to qualify for hospice care to counseling and support services. To learn more about Family Hospice and how we can help, contact us online or call us at 618-277-1800.