Who Pays For Hospice? There are several options when it comes to paying for hospice:
Hospice offers palliative care for not only the patient but also for the family, because it is not only the patient who is suffering. Most patients pay for hospice through Medicare, and most hospice care is given at the patient’s house, but you can also receive hospice care at places like hospitals, assisted living facilities, nursing homes, and hospice facilities.
Hospice isn’t curative care. Instead, it’s for when the patient decides to forgo curative care for palliative care, which focuses on pain and symptom management to make a patient’s final days comfortable. Many different specialists are available to help with hospice care, including neurologists, pulmonologists, occupational therapists, nurses, dieticians, home care employees, and social workers.
Hospice employees who come and care for the patient on a regular basis at your residence also counsel both the patient and the family.
A patient must qualify for hospice and use a Medicare-certified hospice program to receive all or most state or federal hospice benefits.
Medicare
To qualify for the Medicare hospice benefit, two doctors must assess the patient and certify that the patient has only six months to live. The patient will then receive two 90-day periods of hospice. After that, the patient must be re-certified every 60 days as terminally ill to continue hospice care. During these periods, hospice covers the care related to the primary disease and may also cover some care that isn’t.
Diseases aren’t always predictable, and sometimes predicting the amount of time a patient has left is very uncertain, but Medicare offers one consultation with a hospice employee to talk about hospice and you.
You may switch providers only once during each period.
If you have qualified for the Medicare hospice benefit, you pay no more than $5 for medications used to manage or treat pain and the symptoms of the terminal illness. And you will only pay 5% of inpatient respite care as long as Medicare approves the payment amount.
Medicaid
Medicaid is offered for patients receiving SSI (Supplemental Security Income) payments. For the most part, Medicare and Medicaid benefits are very similar. To receive Medicaid-covered hospice care, the Medicare conditions must be met. However, Medicaid programs can vary from state to state, and there is a chance the conditions and benefits may change state to state.
TRICARE
TRICARE is a health benefits program for military and retired military personnel as well as their eligible family members. To find out whether you are eligible for TRICARE and to learn how to apply, you should contact your regional contractor.
TRICARE’s hospice care and structure is very similar to Medicare’s. For example, the benefit periods are the same and you can receive care in your home, a Medicare-certified hospice center, inpatient care, or nursing homes. However, there are no deductibles through TRICARE. The program covers all medical expenses that are related to the terminal illness.
Health Insurance
Private health insurance benefits often include hospice care, especially in policies acquired through an employer. Read through your policy and be sure you understand what is covered. Generally, the hospice care and benefits are the same for private insurance and Medicare, but again, read your policy and make sure.
Medicare also offers private Fee-for-Service plans through private insurance companies. If you have this insurance, they will cover all the hospice benefits while continuing to cover any other services laid out in the plan, such as dental or vision insurance. However, you will still pay the premiums, the coinsurance, and the copayments as written in the plan.
If you have a MediGap policy, your hospice drugs and respite care is covered, as well as other problems not related to your disease.
As with any insurance policy, read the policy carefully so you have a complete understanding of what is covered and what isn’t, what your coinsurance and co-payments will be, and other benefits or payments that are included. If you are unsure of what your policy entails, talk to the insurance provider or a lawyer.
Charity Organizations
Since hospice care currently cannot be denied to patients who qualify for hospice but cannot pay for it, a patient who does not qualify for Medicare, Medicaid, or TRICARE may be able to receive help from donations, grants, gifts, or community programs, allowing the hospice facility to offer care without any charge to the patient.
Most hospice facilities will have a financial specialist who will help patients find a way to receive hospice care.
Hospice has quite a few options when it comes to payment, because terminally ill patients should not have to wonder if they can pay for their care. The program is meant to comfort and assist both patients and their family. Hospice is—and should be—all about the patient and the patient’s family.
Hospice Care Policies
Hospice care is offered through Medicare, so there are some government rules and policies involved. Medicare may review a doctor’s prognosis, especially when their patient lives for more than six months after a terminal diagnosis. The Medicare hospice program is only for the very end of life, but there are some growing pre-hospice programs for patients who are getting close to the end-of-life but aren’t quite ready for hospice. Medicare, however, does not yet cover this.
Healthcare isn’t a simple “you will live this long” or “you will live that long.” With rapidly advancing medical abilities and a more acute medical understanding, the face of medicine is constantly changing. Many diagnoses that were once terminal are now being understood and treated, and we are faced with different problems, such as Alzheimer’s or other diseases that can involve dementia. The loss of brain function is a struggle for both the patient and the family—because who are we if we don’t have our memories?
Doctors are constantly faced with difficult prognoses. Many people will develop the same medical issues, but some will live only a few weeks while others will live for several months or even longer. When struggling with the later stages of cancer or heart failure, is there any way to truly put a timeline on life expectancy?
This has led to some patients having to choose between hospital care and hospice care. Some patients may be afraid to enter hospice care too soon. At what point should a patient turn from curative care to palliative care? This is a choice that only the patient can make. If they are able and content moving ahead with curative care, then that’s what they should do.
Hospice is a great option for many terminal patients. We can’t stop death, for it’s inevitable, and what happens after death is another adventure. As one of J.R.R Tolkien’s greatest quotes ends, “all we have to decide is what to do with the time that is given us.” With family, friends, and hospice, patients can live the rest of their days to their fullest with dignity, with comfort, and hopefully with as many smiles and as much laughter as they can fit in.
