When you or a loved one has been diagnosed with a terminal illness and hospice care is needed, it’s natural to worry about the costs associated with this kind of care. You’ll likely have questions like “Who pays for hospice care?” and “What is included?”
Luckily, hospice patients have quite a few options for covering these costs. This blog will explore who pays for hospice care and what’s covered.
Hospice Care Providers
Whether you or a loved one has private medical insurance or government-funded medical insurance, hospice care costs are covered.
Medicare
This health insurance program for people aged 65 and up provides hospice care coverage under the Medicare Hospice Benefit. As an inclusive benefit, Medicare will pay up to 100% for hospice services related to a terminal illness, whether the patient is in a medical facility or in their home.
Medicaid
Most patients who are on Medicaid are covered for hospice care. To be eligible for this type of medical insurance, you need to either be:
- Low-income individual/family
- Senior individual
- Have a disability
Medicaid offers hospice care at different levels, including standard care at home, respite care, and inpatient care.
Private Insurance
Most private insurance will include hospice coverage benefits, including home care. However, there may be limits or special requirements that need to be met, so it’s a good idea to review your policy thoroughly.
Tricare
This program, run by the Defense Health Agency, provides hospice care coverage for military service members, retirees, and eligible families. Tricare also covers short-term inpatient care.
Charity
For patients and families who are unable to cover the costs of necessary hospice care, there are numerous charity programs which seek to help cover out of pocket costs.
Organizations like the National Hospice and Palliative Care Organization and the American Cancer Society are known to offer financial aid for struggling families.
What is Covered by Hospice?
While this may differ slightly between hospice care providers, generally things like nursing care and personal care (bathing and grooming) is covered by the hospice program or benefit. Other services covered include
- Medication to help reduce symptoms but not in a curative capacity.
- Medical equipment like walkers, wheelchairs and hospital beds can be provided
- Medical supplies such as oral swabs, gloves, wipes, diapers/pull ups, under pads, and protein/meal replacement drinks
- Bereavement counseling
- Physical, occupational and speech therapy
- Short-term respite care
- Wound care
- Podiatry
- Social worker visits
- Spiritual counselor visits
- Volunteer support
What’s Not Covered by Hospice?
Depending on what medical program you’re on, there may be some limits to what is paid. These excluded services might include:
- Curative treatments
- Certain specialized medical equipment (contact our team for further information)
- Medical transportation to and from appointments
- Caregivers
Choose The Best Hospice Provider in Orange County
Choose a hospice provider that understands the complex emotions during this time. Choose Orange Hospice to care for you or a loved one. At Orange Hospice, we provide physical, emotional, social, spiritual, and bereavement care to support the patient and their family.
Contact us today at (714) 790-0594 to learn more about us and how we can provide the best tender care for your loved one.
FAQs
1. Is hospice care free, or are there costs for hospice?
Most medicare beneficiaries and hospice services are covered at little to no cost under the Medicare Hospice Benefit when the patient is terminally ill, and the illness follows its normal course. That means, while hospice is not technically “free,” most patients pay nothing for covered services, and costs for hospice are typically limited to small copays for certain medications or inpatient respite care.
2. Are hospice services covered by Medicare if I’m in a Medicare Advantage Plan?
Yes. Are hospice services covered by Medicare even if you are enrolled in a Medicare Advantage Plan? When hospice is elected, coverage shifts to Original Medicare under the Medicare Hospice Benefit, while your Medicare Advantage plan may continue to cover unrelated services. Hospice helps coordinate benefits and explains coverage clearly during admission.
3. What hospice services are included in Medicare hospice coverage?
Hospice Coverage includes physician-directed services, physician Services, and care from an interdisciplinary care team. Covered services typically include skilled nursing services, symptom management, end-of-life pain management, medications, medical supplies, home medical equipment, spiritual care, medical social services, and bereavement counseling. Care is guided by an individualized care plan based on the patient’s medical prognosis and hospice diagnosis.
4. Are therapy services covered under hospice care?
Yes, when they support comfort and function rather than cure. Hospice may include skilled therapy services such as physical therapy, occupational therapy, and speech therapy to help with safety, mobility, and quality of life. These services are coordinated by the hospice medical provider and adjusted as needs change.
5. Does hospice cover inpatient care, respite care, or nursing facilities?
Yes. Medicare hospice coverage may include short-term inpatient care in an inpatient hospice facility, hospital inpatient unit, or skilled nursing facility when symptoms cannot be managed at home. Hospice respite care and inpatient respite care are also covered to give caregivers temporary relief. Hospice can provide care in assisted living or a nursing home, though room and board are usually not covered unless inpatient care is medically necessary.
6. What services are not covered by hospice?
Hospice does not cover curative treatments for the terminal illness, ongoing emergency department care unrelated to comfort, or certain interventions such as tube feedings if they are intended to prolong life rather than provide comfort. Ambulance transportation and unrelated hospital services may not be covered unless arranged by the hospice. Hospice explains these limits clearly as part of Patient Rights education.
7. How does hospice care compare to palliative care for coverage?
While palliative care can be provided alongside curative treatment and may involve separate billing, hospice care is a comprehensive benefit once a patient has a terminal illness and limited prognosis. Hospice assumes responsibility for care related to the terminal condition, focusing on comfort, dignity, and coordinated end-of-life support.
