Hospice Costs and Benefit Options
Because the decision to seek hospice care generates intense feelings-anxiety, isolation, grief and confusion, it is helpful to know that financial support is available. As with all other aspects of senior living, understanding the financial obligations and benefits before the time of need can significantly lessen anxiety.
The costs associated with hospice care are predominantly (80-90%) covered by Medicare and Medicaid. Approximately 15% is paid by third party health insurance and private pay is very rare.
Medicare Hospice Benefits
Medicare benefits are available when an individual meets all of the following conditions:
- You are eligible for Medicare Part A, which is Hospital Insurance.
- Your doctor and the hospice medical director certify that you are terminally ill and have six months or less to live if your illness runs its normal course.
- You must sign a statement choosing hospice care instead of the Medicare-covered benefits to treat your terminal illness. Medicare will continue to pay for covered benefits for any health problems that aren’t related to your terminal illness.
Many individuals fear that accepting Medicare benefits for hospice care will mean that they are no longer eligible for other medical benefits the patient may require, but this is not the case. It is vital for patients to be informed about all of their options so that they can make the most advantageous decision at this point in their lives.
A landmark research effort concerning hospice was completed by Duke University in 2007, finding that hospice reduced Medicare costs by $2,309 per hospice patient. Mr. J. Donald Shumacher, President and CEO of The National Hospice and Palliative Care Organization, explains the importance of those findings:
The trends for increased usage of hospice are expected to continue as we see an aging population of baby boomers face end of life situations for themselves and their parents. Hospice helps people live with dignity, comfort and compassion during life’s final journey—to know definitively that it provides a cost savings to Medicare is an additional benefit.
Medicaid Hospice Benefits
As of 2006, 45 states plus the District of Columbia offer hospice care as a covered Medicaid benefit. These benefits parallel the Medicare benefit, although the exact benefit will vary in certain states.
Veterans’ Hospice Benefits
Hospice, including home hospice care, is a covered benefit for all enrolled veterans. Visit The National Hospice and Palliative Care Organization for information concerning hospice benefits for veterans which include:
- Provision for needed hospice care for all levels, including in-home, respite, inpatient and crisis.
- Inpatient hospital bed for use in the home.
- Referral assistance to area community hospices and a designated hospice contact person
- An interdisciplinary care consult team
Private Health Insurance
During the past 10 years, it has become more common for private health insurance policies to include a hospice benefit that covers some or all of the services provided under Medicare and Medicaid. Coverage, co-pays and eligibility requirements are insurance company specific.
Long-Term Care Insurance Hospice Benefits
It is likely that private long-term care insurance does include a hospice benefit. A policy holder would verify this and the limits of those benefits at the time of purchase.
The relatively recent introduction of hospice care in the United States as well as the sensitive nature of the need for such service, can lead to misunderstanding and may consequently hinder the full power of hospice services. The evolution of hospice, through experience and education has been remarkable and continues to grow as it becomes an accepted and sought-after aspect of medical care.
End of life issues are surely a challenge for every individual, their families and friends. It is somewhat comforting to keep in mind that, at the end of the day, no one is ever turned away from needed hospice care for financial reasons.
Written by senior housing writer Marky Olson.
