Who Pays for Hospice?

Who Pays for Hospice?

One of the first questions that many families ask us about hospice is, “How do we pay for hospice care?”

Regardless of your financial needs, you can afford hospice care for your loved one. At Golden Rule Hospice, we ensure that no terminally ill patient is excluded from participation in or denied benefits of any hospice care because of an inability to pay for hospice care.

Hospice care is paid for by Medicare, Medicaid, the Department of Veterans Affairs, and most private insurance plans, HMOs, and other managed care organizations. Medicare will cover the hospice care you get for your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice program.

That means that out-of-pocket expenses are minimized, and in many cases, there may be no out-of-pocket costs.

How Medicare Coverage Works for Hospice Care

Hospice care services are covered by Medicare Parts A and B. Medicare Part A provides up to 100% coverage for hospice care that is related to a terminal illness.

For other hospice services, Medicare Parts A and B apply. That means that depending on deductibles and co-payment requirements, there may be some out-of-pocket costs.

Take note that Medicare coverage applies regardless of the setting of care. So, whether a patient is receiving at-home care or is at a nursing facility, Medicare will cover expenses.

It is important to know, however, that Medicare’s coverage does not extend to room and board at a nursing facility. That is where Medicaid coverage comes into play.

To receive Medicaid coverage for room and board, a patient must meet the eligibility requirements set by the state of Georgia.

A Medicare Advantage Plan, like an HMO or PPO, is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits.

Original Medicare covers all Medicare-covered services you get while on hospice care, even if you were previously in a Medicare Advantage Plan or other Medicare health plan. Once you choose hospice care, your hospice benefit covers most of your needs.

Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions.

You can choose to get Medicare covered services that aren’t part of your hospice care through your Medicare Advantage Plan or through Original Medicare. If your plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services as long as you continue to pay your premium.

What If You Do Not Have Medicare or Medicaid?

98% of patients that require hospice care are covered by Medicare or Medicaid, but some patients may not have either.

If that is the case, your private insurance plan may include coverage for hospice services.

If that coverage has gaps, or if you do not have that type of coverage, there may be other payment sources you can lean on, like charitable donations.