Who pays for Hospice?

Does Medicare cover hospice?
Hospice is covered by Medicare, Medicaid and most private insurance

Congress established the Medicare hospice benefit in 1982 to provide patients with life-limiting illnesses compassionate, coordinated care to manage the symptoms and consequences of their disease.  Medicare’s hospice benefit was designed to help terminally ill patients with the often significant expenses incurred at the end of life, including prescription and over-the-counter drugs, medical equipment and supplies, hospital co-payments and grief support for the family.

While the benefit offered a lifeline to terminally ill patients covered by Medicare (later extended to Medicaid and to most private insurance plans), it enacted a number of requirements that providers must meet in order to be certified as hospices by Medicare and qualify for payment from Medicare.  These include the mandate to provide or manage all services needed to manage the terminal illness.

Is hospice care covered by insurance?

Hospice coverage is widely available. It is provided by Medicare nationwide, by Medicaid in most states, and by most private health insurance policies. To be sure of coverage, families should, of course, check with their employer or health insurance provider.

Are there any additional expenses to be paid?

Medicare covers all services and supplies related to the life-limiting illness for the hospice patient. In some insurance cases, the patient may be required to pay a 5% or $5 “co-payment” on medication and a 5% co-payment for respite care. You should find out about any co-payment when choosing a hospice.

If the patient is not covered by Medicare, or any other health insurance, does hospice still provide care?

The first thing hospice will do is assist families in finding out whether the patient is eligible for any coverage they may not be aware of. Barring this, most hospices will provide care for those who cannot pay, using money raised from the community or from memorial or foundation gifts.

How long can you get hospice care?

Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.

Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of the first 90-day benefit period, your hospice doctor and your regular doctor or nurse practitioner (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less). At the start of each benefit period after the first 90-day benefit period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care. 

A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day benefit period ends.

Can you stop hospice care once it has started?

If your health improves or your illness goes into remission, you may no longer need hospice care.  You always have the right to stop hospice care at any time. If you choose to stop hospice care, you’ll be asked to sign a form that includes the date your care will end. You shouldn’t be asked to sign any forms about stopping your hospice care at the time you start hospice. Stopping hospice care is a choice only you can make, and you shouldn’t sign or date any forms until the actual date that you want your hospice care to stop.