If you or someone you love is terminally ill, you may think of turning to Hospice Care for help. Hospice care focuses on helping terminally ill patients live comfortably and includes pain relief care and symptom management. With hospice, the focus is no longer on getting better or finding a cure, but instead on living well while dying. If you or a loved one are at this point in life, you may wonder about the costs of hospice care. Who will pay for the care you need?
Out of Pocket Coverage for Hospice Care
Medicare does not cover long-term care. You could need long-term care if you develop an illness where you need a skilled nursing facility or assisted living facility for months or years on end. Those with dementia or other diseases that cause mental deterioration often need long-term care. Health insurance does not cover long-term care.
With an illness that requires continuous care but is not terminal, you’ll need long-term care. Hospice care sometimes happens in a long-term care facility, but it is not the same as long-term care. Many choose to pay for long-term care with special insurance or Medicaid coverage.
However, suppose you need long-term care because you are terminally ill with a prognosis of 6 months or less to live. In that case, you may qualify for hospice care coverage from Medicare, the Veteran’s Health Administration, or Medicaid.
Medicare Coverage for Hospice Care
Medicare Part A insurance covers many medical needs, including inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery, home health care. If you have Medicare Part A, you can get hospice care benefits if you:
- Use a Medicare-certified hospice
- Have a doctor who certifies you terminally ill, with a prognosis of 6 months or less to live
- Sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions
The hospice benefit is given in increments of 90 day periods with recertification by your physician. After this time, a doctor must recertify your condition as terminal in a face-to-face appointment every 60 days. Medicare pays hospice at a daily rate based on the level of care. There are four types of daily care that Medicare pays for:
- Routine Home Care: If you get hospice care at home, a skilled nursing facility, or an assisted living facility home without continuous care. Routine home care is the name for the level of care when you are not in a health crisis.
- Continuous Home Care: Nursing care constantly in a home setting (not an inpatient facility such as a hospital, skilled nursing facility, or hospice inpatient unit). This care may also include a Hospice aide or homemaker services. This type of care is only for brief periods of crisis as needed to stay at home.
- Inpatient Respite Care: In an approved inpatient facility for up to 5 consecutive days to give their caregiver a rest.
- General Inpatient Care: In an inpatient facility for pain control, acute or chronic symptom management that other care levels cannot manage.
Hospice Services Covered by Medicare
- Services from a hospice-employed physician, nurse practitioner (NP), or other physicians chosen by the patient
- Nursing care
- Medical equipment
- Medical supplies
- Drugs to manage pain and symptoms
- Hospice aide and homemaker services
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Dietary counseling
- Spiritual counseling
- Individual and family or just family grief and loss counseling before and after the patient’s death
- Short-term inpatient pain control and symptom management, and respite care
Even with Medicare coverage for hospice, you may owe coinsurance to your hospice provider for drugs and biologicals. These treatments manage your symptoms and decrease your levels of pain.
Medicare Does Not Cover
Medicare will not pay for room and board. In addition, there are treatments that Medicare does not cover, including:
- Life-saving medical treatments to cure a terminal illness.
- Room and board, including long-term residence in the patient’s home, a nursing home, or a hospice facility.
- Any prescription medication to cure or rehabilitate the terminal illness.
- Hospice care outside of the designated hospice provider. The patient’s appointed hospice care team must organize all treatments.
- Outpatient or inpatient hospital care and ambulance transportation. Exceptions to this rule are if the patient’s hospice care team has scheduled care or the care is unrelated to the terminal illness. (1)
Medicaid can cover long term care and hospice care, including room and board. However, to get Medicaid coverage, you must spend down your assets on medical needs to be eligible. If you spend down all of your money and assets to medically treat your condition, you may become eligible for Medicaid.
If your assets and income are meager and you qualify for Medicaid coverage for hospice costs, then your benefits are very similar to those under Medicare coverage. However, Medicaid will also cover your room and board in addition to the treatments your doctors prescribe.
We Can Help
It is emotionally challenging to consider hospice care for yourself or a loved one. Still, your decision to choose comfort and pain relief may relieve some of your fears and anxieties. At Renaissance, we want to come alongside you and your family as you make the difficult decisions surrounding end-of-life care. We are here when you are ready to start planning end-of-life services. As you move forward with celebrating your loved one’s legacy and remembering the good times together, we provide a place for you to connect with your loved ones in a meaningful way. Contact us today to see how we can help in your situation.