Ways to Pay for Hospice Care
Trying to figure out how to pay for medical expenses can be stressful and, frankly, exhausting. When managing end-of-life care, figuring out how to pay for hospice is draining–especially if you don’t know what options exist out there.
Trying to figure out how to pay for medical expenses can be stressful and, frankly, exhausting. When managing end-of-life care, figuring out how to pay for hospice is draining–especially if you don’t know what options exist out there.
Generally, to receive hospice care benefits from any of the following programs and policies, you must have a terminal condition with a prognosis of fewer than six months left to live and agree to stop any curative treatment for that condition. That said, it does not mean that you must be six months away from death in order to receive any benefits. It is a general range of time, and even if you or your loved one outlive the six months, you can still reapply for hospice.
If you have a combination of payment options, you may want to figure out how to best apply them. Let’s take a look at common ways to pay for hospice care:
Medicare Part A (Hospital Insurance)
Most people are aware of the federal benefits program known as Medicare, which covers health care for many people over the age of 65 and others. Those who qualify pay nothing for hospice care services under Medicare Part A.
To qualify:
- You must use a Medicare-certified hospice provider
- Your hospice doctor and your primary doctor must certify that you have a terminal illness with a life expectancy of six months or less
- You must elect hospice care instead of curative treatments for your terminal illness
If you qualify, nearly every hospice service your hospice care team arranges is fully covered by Medicare. The most notable exception is room and board. If you choose an inpatient hospice care facility, you will be responsible for room and board costs. You may also owe up to $5 per prescription for any outpatient medications you need for pain or symptom management. Additionally, should you require inpatient respite care, you may have to pay 5 percent of the Medicare-approved amount.
Medicare Advantage
Medicare Advantage (MA) plans, also called Medicare Part C, do not cover hospice care. Medicare Part A plans will cover hospice care services for Medicare Advantage policyholders. You just need to make sure the hospice provider you choose is Medicare-approved. If your Medicare Advantage plan includes prescription drug coverage, any medications related to pain or symptom management might be fully covered, which would mean no $5 copay.
Medicaid
Medicaid benefits can vary between states, as it is a state-based program and not a federal one like Medicare. You may have to check with your state’s Medicaid website or look up your plan to see what coverage you have.
If a Medicaid plan does include hospice coverage, it typically should cover at least 210 days of hospice services, counseling services for family members and the patient, home health aides, and other related end-of-life services. Additionally, individuals under the age of 21 who use Medicaid to pay for hospice services can continue to receive life-saving or curative treatments while on hospice.
Veterans Assistance
The Department of Veteran Affairs offers full hospice care coverage for enrolled veterans if they meet clinical qualifications for the benefit. There are no out-of-pocket costs or copays. Alongside symptom and pain management, the VA also covers bereavement support for family members and loved ones.
Veterans deserve to die with dignity. Let’s take a look at what the VA does to help.
Private Health Insurance
Most private health insurance plans can mirror the federal Medicare hospice benefit. That often means full hospice care coverage, again if the patient can meet criteria. However, not all services may be covered the same way, which can include respite care and medication copays.
Long-Term Care Insurance
As the name implies, long-term care (LTC) insurance helps individuals pay for long-term care expenses. LTC policies can vary, but most cover any type of long-term care service or facility. This can also include hospice care in your home or staying in a hospice facility. Since most policies cover nursing home room and board, you could use your LTC insurance to pay those costs while using Original Medicare or private insurance to pay for hospice care services.
What’s The Best Way to Pay for Hospice Care?
Maybe you have more than just one option available to you, having saved up some money and invested it in a long-term care plan. Or perhaps you are just tapping into your Medicare benefits to aid you in this time. Regardless of the payment forms and benefits, knowing how to pay for hospice care is one of the first steps to making sure you are prepared for end of life.
References
- “Hospice Benefits.” Medicaid.gov, Centers for Medicare & Medicaid Services (CMS), www.medicaid.gov/medicaid/benefits/hospice-benefits/index.html.
- “Hospice Toolkit: An Overview of the Medicaid Hospice Benefit.” Centers for Medicare & Medicaid Services (CMS), February 2016, www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/hospice-overviewbooklet.pdf
- “Hospice Care.” U.S. Department of Veterans Affairs, 13 April 2020, www.va.gov/GERIATRICS/pages/Hospice_Care.asp.
