Who pays for hospice care?
Home hospice care usually costs less than care in hospitals, nursing homes, or other institutional settings. This is because less high-cost technology is used, and family and friends provide most of the care at home.
Medicare, Medicaid in most states, the Department of Veterans Affairs, most private insurance plans, HMOs, and other managed care organizations pay for hospice care. Also, community contributions, memorial donations, and foundation gifts allow many hospices to give free services to patients who can’t afford payment. Some programs charge patients according to their ability to pay.
To get payment from Medicare, the agency must be approved by Medicare to provide hospice services.
To qualify for the Medicare hospice benefit, a doctor and the hospice medical director (also a doctor) must see the patient and certify that the patient has less than 6 months to live if the disease runs its normal course. The hospice benefit starts with 2 periods of 90 days each, then an unlimited number of 60-day periods. The doctor or nurse practitioner must re-certify the patient in a face-to-face visit before the third election period, then again before each benefit period after that. This means that the patient must be seen by their own doctor and the hospice doctor to be certified for the first 180 days of hospice care. After the first 180 days, the patient must be seen again to be re-certified every 60 days for as long as the patient is getting hospice care.
The patient signs a statement that says he or she understands the nature of the illness and of hospice care, and that he or she wants to be admitted to hospice. By signing the statement, the patient declines Medicare Part A and instead chooses the Medicare hospice benefit for all care related to his or her cancer. The patient can still receive Medicare benefits for illnesses that aren’t related to cancer. A family member may sign the statement if the patient is unable to do so.
If you’re not sure how hospice might work for you, Medicare offers a one-time only hospice consultation. You can meet with a hospice medical director or hospice doctor to discuss your care options and treatment needs. You don’t have to choose hospice care if you use this consultation service.
In 1986, laws were passed to allow the states to develop coverage for hospice programs. Most states have a Medicaid hospice benefit, which is patterned after the Medicare hospice benefit.
Most private health insurance companies include hospice care as a benefit. Be sure to ask about your insurance coverage, not only for hospice, but also for home care.
If insurance coverage is not available or does not cover all costs, the patient and the family can hire hospice providers and pay for services out of pocket. Some hospices are able to provide services without charge if a patient has limited or no financial resources.
Last Medical Review: 04/30/2013
Last Revised: 04/30/2013