How to Pay for Hospice Care

How to Pay for Hospice Care

It is common for people to arrive at a place in life where they need hospice care. At this time, a very common question is how to pay for hospice care. It is much easier than most people think.

Most hospice patients are eligible for Medicare. This covers every aspect of hospice care and hospice services. Through Medicare, there is no deductible for hospice services. However, there may be a small co-payment for prescriptions and for other aspects of respite care.

It is important to note that Original Medicare covers hospice even if you’re in a Medicare Advantage Plan.

Many private health insurance plans offer a hospice benefit. However, the extent to which they cover hospice care and services may differ from Medicare. Furthermore, it may be different from one to another. For example, if you have a private health insurance plan, explore what their coverage offers.

In addition to those options, military families have hospice coverage through Tricare. The benefits offered through Tricare are extensive.

If you are not covered by one of these scenarios, you may always choose to pay on your own. All hospices will accept private payment, referred to as “self-pay.”

What if you have the need for hospice but have no insurance and no way to pay for it? Fortunately, many hospices have some ways that they can offer services to people who are medically eligible but have neither insurance nor the resources to pay for their care. Look into their charity care options.

Paying for Hospice Care in Benefit Periods

Hospice care is managed in something called “benefit periods”. You can get hospice care for two 90‑day periods followed by an unlimited number of 60‑day periods. However, eligibility generally relies on a physician’s position that the patient’s life expectancy is at 6 months or less. Neither the patient, nor the physician, is penalized if the patient outlives the 6 months period. The patient can be re-certified for as long as they continue to be medically eligible.

It is common with hospice care that a patient’s condition may stabilize or even improve. A patient may improve to a place that they no longer meet medical eligibility for hospice services. If this happens, the patient is “discharged” from the hospice program. Also, their Medicare benefits go back to the coverage they had prior to receiving hospice care.

There are times that hospice patients may choose to pursue curative therapies such as entering a clinical study for a new medication or procedure. If this is the case, the patient must withdraw their treatment of hospice care. This is called “revocation.”
All patients who are discharged, and any who choose to leave hospice care, may re-enroll without penalty anytime they meet the medical eligibility criteria.

Have questions about how to pay for hospice care? Just ask.

We are always happy to help you better understand how to pay for hospice care. If you have any questions about costs, coverage, out-of-pocket expenses, etc., don’t hesitate to ask! Our staff can help you understand the coverage provided by whatever insurance provider you have.