Who Pays for Hospice and Palliative Care?
Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions:
What hospice services does the Medicare Hospice Benefit cover?
Medicare covers these hospice services and pays nearly all of their costs:
Medicare pays the hospice for your hospice care. You may have to pay:
What services are not covered?
The care that you receive for your terminal illness must be from a hospice. When you choose hospice care:
Medicare won't pay for any of the following:
In addition to home care, the Medicare and Medicaid Hospice Benefits do cover short-term stays in a hospital, hospice facility and nursing facility. These short stays include respite care of up to five days, and general inpatient care when a person is admitted for pain or symptom management and is discharged when the pain and/or symptoms are under control.
Adapted from U.S. DEPARTMENT OF HEALTH AND HUMAN SRVICES, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Publication No. CMS 02154. Revised July 2003
What Is The Medicaid Hospice Benefit?
Medicaid is health insurance that helps people who can not afford to pay some or all of their medical bills. Medicaid is available to those individuals that meet the financial eligibility requirements set by their state law. Under Medicaid, like Medicare, there is a Hospice Benefit. The Medicaid Hospice Benefit is an optional benefit that individual States may choose to make available to people in the Medicaid program. 47 States currently have the Medicaid Hospice Benefit.
Please contact the National Hospice and Palliative Care Organization's HelpLine at 800/658.8898 to find out if your state has the Medicaid Hospice Benefit.
The Medicaid Hospice Benefit covers the same services that the Medicare Hospice Benefit covers. However, there may be some differences, so it will be important for you to ask your hospice provider about the services provided under your state's Medicaid Hospice Benefit.
Most private health insurance policies have a hospice benefit that includes some or all of the services provided under the Medicare and Medicaid Hospice Benefits. To find out if your health insurance has a hospice benefit, contact your health insurance representative. If your insurance has a hospice benefit, make sure to ask if the benefit covers all hospice services and what costs you may be asked to pay.
How is Palliative Care Paid For?
In addition to hospice care, there are other end-of-life care services that you may choose to use. Palliative care works much like hospice services, but can be provided to a person at any time during their illness, which is different from hospice's defined set of services.
Currently Medicare and Medicaid do not offer a ‘palliative care' benefit. The palliative care services covered will depend upon your Medicare, Medicaid, or private insurance coverage. It is important for you to ask the palliative care provider how or if the services will be covered and what, if any, costs you will be asked to pay.
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