Who Pays for Hospice Care?

Hospice care is patient/family-centered care that offers medical care, pain and symptom management, and other emotional, spiritual, and practical support to individuals living with an advanced progressive illness. Hospice providers often offer services wherever our patients call home, whether a personal residence, long-term care community, assisted living facility, nursing home, inpatient unit, hospital, or wherever else the individual is most comfortable.

Unfortunately, we often hear from patients and families that they wish they knew about hospice services sooner. Many are reluctant to think or talk about these services, so many aspects of hospice care are unknown until after a health crisis.

Oftentimes individuals and families seek answers after a health emergency has arisen – during a time that already includes overwhelming emotions and care decisions to consider. During times of crisis and stress, these uncertainties can sadly delay or deter individuals from making the decision to receive support from hospice. By eliminating some of the unknowns of hospice before services are needed, you can be prepared by knowing what type of care is best for you or your loved ones.

Medicare Hospice Benefit

Many Medicare beneficiaries are shocked to learn that a hospice benefit exists within their Medicare coverage. The Medicare hospice benefit, enacted by Congress in 1982, is the predominant source of payment for hospice. At present, Medicare covers the cost of care for more than 85 percent of all individuals receiving hospice care from Medicare-certified providers.

What Services are Covered Under the Medicare Hospice Benefit?

A Medicare-certified hospice provides the same core services to all its patients, regardless of its pay source. This benefit covers 100% of the following services for an individual’s advanced, illness and other related conditions;

• Doctor Services
• Nursing Care
• Certified Nursing Assistants
• Medications for pain and symptom management
• Medical Equipment (such as a hospital bed, wheel chair, and shower chair)v
• Medical Supplies (such as gloves and catheters)
• Social Work Services
• Pastoral Care
• Dietary counseling
• Physical, occupational, and speech therapy
• Short-term Inpatient Care (for pain and symptom management)
• Short-term respite care
• Grief and loss counseling
• Any other Medicare-covered services needed to manage pain and other symptoms, as recommended by your hospice team

What Services Are Not Covered Under the Medicare Hospice Benefit?

• Care outside the hospice plan of care
• Room and board in a nursing home
• Care from another provider that duplicates hospice care
• Treatment intended to cure or modify the terminal illness in absence of specific symptoms

*Additional information about the Medicare Hospice benefit can be found at www.medicare.gov*

Other Payment Sources for Hospice

Medicaid (in most states), the Veteran’s Health Administration (VHA), and many commercial insurances cover most, if not all, of hospice services as well. Medicaid and the VHA mirror the Medicare hospice benefit with some small differences. Most private and commercial insurances provide some coverage for hospice care, but there are variations in qualifications and covered benefits. If you are considering hospice care and do not have benefits through Medicare, Medicaid, or the VHA, it is important to check with your insurer whether hospice care is covered and under what circumstances.