Anyone terminally ill with six months or less to live can be considered for hospice care treatment. In almost all cases, insurance covers hospice services, whether you have Medicare or private insurance.
Hospices aim to provide comfort from pain, management of symptoms and emotional and spiritual support when curative treatment is no longer beneficial.
It’s important to remember that if a patient’s condition improves, they can move out of hospice care with the understanding that insured services can be reinstated when needed. Also, If a terminal patient lives longer than six months, they can continue to receive hospice services.
That said, hospice is often used as a generic term for end-of-life care and confusion surrounds what it entails and what it covers.
Here’s a brief explanation of what’s covered depending on the type of insurance you have.
If You have Medicare
To receive Medicare benefits for hospice care, your doctor must certify you’re terminally ill. You must also sign a statement saying you will accept comfort care instead of care to treat or cure your illness.
Under Medicare, there are no copayments for hospice care. You may have a small copayment for pain relief and symptom control prescriptions, which may also be covered under your Medicare Part D prescription drug plan.
Under Medicare regulations (and most insurers) hospice services include the following:
- pain and symptom management
- 24-hour on-call service
- in-person visits
- medical equipment
- related medications
- inpatient care to manage acute bouts of pain
- continuous care in the home
- volunteer services
- spiritual care
- bereavement and counseling services
- art and music therapies.1
Family and caregivers get help too. Medicare provides for respite care. With this service, the patient may be temporarily admitted to a hospice facility or hospital to provide a break for the caregiver.
IMPORTANT: To ensure you receive all of the available benefits available, make sure a Medicare-approved doctor refers you for hospice care. In addition, make sure your hospice provider, whether it is in the home or a facility, accepts Medicare payment for full services.2
If You Have Supplemental Medicare Insurance
You likely won’t need much in the way of Medicare Supplement Insurance, also known as Medigap, if you are paying through Medicare. Why? Because Medicare Part A covers hospice care without copayments or deductibles, you are not likely to pay many out-of-pocket costs.
But you will face copayments for pain-relief medications, respite care, and any services to treat conditions not related to your terminal illness. Your supplemental Medicare policy may help pay for these out-of-pocket expenditures.
If You Have Medicare Advantage
If you need hospice and have a Medicare Advantage Plan, your policy can help you find a hospice provider that accepts Medicare.
Medicare Part A covers hospice services, for both original Medicare and Medicare Advantage recipients. When you receive hospice care you can stay in your Medicare Advantage plan as long as you pay premiums. It’s a good idea to keep your Medicare Advantage coverage so you can access services to treat other health conditions not related to your terminal illness.3
If you leave hospice care, your Medicare Advantage Plan will start again for full coverage the first of the following month.4
If You Have Private Insurance
Most private insurance plans cover the full cost of hospice care and define it and its accompanying services under the same guidelines as Medicare. Unlike Medicare, however, each may have unique requirements a patient must meet before they undergo hospice care. Moreover, patients with private insurance may encounter different out-of-pocket costs for certain aspects of hospice care.
Every plan is different. So contact your private insurer to determine exactly what’s covered and what costs you may incur.5
One caveat: No matter what your coverage, choosing high-quality hospice care can be challenging. Growth in the for-profit side of the industry has led to troubled providers with faulty management entering the field. The result can be large gaps in service, inadequate care, and even outright fraud.