Who Pays for Hospice?
Healthcare can be very expensive.
Those who are in hospice may need numerous medications for pain control, in addition to nursing care, and other services.
When you or someone you love is considering hospice care, one of the first questions you may ask is, “How do I pay for hospice?”
Is hospice covered by insurance? Will Medicare cover hospice care? What if I can’t afford hospice?
We know that many of hospice providers have programs with a lot of details that can make them confusing.
That’s why we’ve broken down a few items to help you understand who pays for hospice and what you can expect as far as out-of-pocket costs.
You’ll learn that a lot of this is based on whether you’re using a for-profit or nonprofit hospice.
Here are some useful guidelines with more information.
Under the original Medicare, you pay nothing for hospice care. However, there may be copayments involved for certain services, particularly if you’re receiving hospice at a hospital as an inpatient.
Does Medicare Cover Hospice?
Under the original Medicare, you pay nothing for hospice care.
However, there may be copayments involved for certain services, particularly if you’re receiving hospice at a hospital as an inpatient.
Sometimes there is a copayment for medicines that treat symptoms while you’re having hospice care at home. But it’s usually no more than $5 for each prescription drug.
You may need to check with your Medicare drug plan to determine if you’re eligible for some medication coverage under Part D.
If you’re receiving inpatient care while staying at a hospice house or care center, you may need to pay 5 percent of the Medicare-approved amount.
It’s important to note that while Medicare covers hospice care, it doesn’t cover room and board if you receive hospice care in your home, or another facility such as a hospital or nursing home.
Medicare Part A (Hospital Insurance)
In order to receive hospice care under the Medicare Part A, you have to meet the following conditions:
- Your physician and your hospice doctor agree, and certify, that you have a life expectancy of six months or less.
- You decide NOT to seek curative care to try to get well.
- You accept palliative care for your illness.
- You must choose hospice care instead of other Medicare-covered benefits. You will have to sign a statement to confirm this.
What Medicare Won’t Cover
When you start receiving your hospice benefit, there are certain things that Medicare will not cover. It’s important to be aware of these items.
In general, when your hospice benefits start, Medicare will NOT cover:
- Any plan of care that is designed to cure your illness
- Any medicines that are meant to treat your illness.(Medicare only covers drugs for pain relief or symptom control.
- Any hospice provider that was NOT from the hospice team you chose
- Room and board
Where to Go for More Information on Medicare and Hospice
Medicare plans can be confusing.
Usually a hospice organization has someone who will help you in determining your benefits.
You may also want to review the specifics of what Medicare covers from its official U.S. Government website.
If you have any detailed questions, it’s important to make a list of them and ask your Medicare representative or a member of your hospice team.
Will My Insurance Cover Hospice?
Most insurance companies offer some type of hospice care if you meet certain qualifications.
Obviously, the details of your coverage will depend upon your individual policy.
Most of these plans require that the patient be only seeking palliative (comfort) care. Not seeking treatment to cure the disease.
If I Don’t Have Insurance Can I Use Hospice?
Yes. You can use hospice even if you don’t have insurance.
However, your out-of-pocket costs will often depend upon whether you’re seeking care from a for-profit hospice or a not-for-profit hospice.
You can use hospice even if you don’t have insurance.
Advantages of Not-for-Profit Hospices
Both non-profit and for-profit hospitals are required to abide by all regular requirements set forth by the local and federal governments.
The main difference is that not-for-profit hospices often provide care to individuals regardless of their ability to pay.
Some may provide services without cost while others may offer them on a sliding scale, meaning you may pay more or less depending on your financial health.
Non-profit hospices are funded in part by donations and foundations. This is how they are able to help people who can’t afford hospice services under normal circumstances.
If you need services and are unable to pay for hospice care, you should speak to a representative from a non-profit hospice. We would be happy to help you get connected to someone in your area.
Is Hospice Free?
No. While many not-for-profit hospices will provide free services, regardless of your ability to pay, these services still cost money.
Often, not-for-profit hospices depend upon donations and benefactors to support their programs.
This enables them to offer services to those like the uninsured, the underinsured and those without Medicare.
Therefore, donations are very important to these organizations because they enable them to help the community.
Depending upon your situation, you may not have to pay for hospice care at all, or only pay a very small amount.
But again, it’s not accurate to say that hospice services are “free.”
How Much Does Hospice Cost?
The cost of hospice care varies. One large factor that determines cost is whether or not you’re seeking care at a hospital or facility, or seeking hospice care at home.
Cost can also depend on the different medications you’re taking, the type of illness you have, and the amount of nursing or medical attention you need.
However, non-profit hospices offer choices to help those who can’t afford hospice care or who are uninsured. In these cases, the cost is absorbed by the organization, and paid for through charitable donations.
Don’t Let Financial Issues Keep You From Seeking Hospice Care
Many of those who have benefitted from hospice care often say the same thing: I wish I had started sooner.
If you have questions about what is covered, talk to your hospice care team who can guide you to resources where you’ll find answers.