Who Pays for Hospice Care?

According to Vitas Healthcare, Medicare pays for 100% of hospice care provided in the U.S. Most private insurers and HMOs also offer a hospice benefit, but may not offer the same level of service that Medicare and Medicaid provide. If you do not have insurance and are not eligible for Medicaid or Medicare, you will need to pay for hospice yourself. This is very unusual, however, since almost everyone who has a terminal illness will qualify for either Medicare, Medicaid or both.

Medicare is required to pay for all necessary services for terminally ill patients who are eligible for Medicare Part A (the Medicare hospital benefit), including hospice care. This is true even if the patient is enrolled in a Medicare Advantage Plan (Medicare Part C). However, before a person can be enrolled in hospice, the following conditions must be met:

• A doctor and the hospice medical director must certify that the person is terminally ill and has six months or fewer to live.
• The person or their legal guardian must sign a statement choosing hospice care instead of other Medicare-covered services to treat the terminal illness (for example, cancer chemotherapy or other curative care). (Note: This does not apply to beneficiaries who are under 21 years old.)
• Care must be provided by a Medicare-approved hospice provider.

As a general rule, Medicare will pay all of the costs for the following services as long as they are deemed medically necessary by the patient’s physician or hospice team, according to Medicare.gov:

• Doctor services
• Nursing care
• Medical equipment (like wheelchairs or walkers)
• Medical supplies (like bandages and catheters)
• Prescription drugs for symptom control or pain relief (a small copayment of no more than $5 may be required)
• Hospice aide and homemaker services
• Physical therapy 
• Occupational therapy 
• Speech-language pathology 
• Social work services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care (for pain and symptom management)
• Short-term respite care in a hospital or nursing home so a family caregiver can take a break (you may need to pay 5% of the Medicare approved amount for this stay)
• Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions

With few exceptions, Medicare does not cover care aimed at curing a patient’s underlying illness (for example, chemotherapy for cancer) once they are enrolled in hospice. Additionally, it will not cover services from a hospice provider other than the hospice in which the patient is enrolled. It will, however, cover medical care provided by the patient’s primary care physician if that is the practitioner the person chooses to supervise their care. 

Sources

“How to Pay for Hospice Care (Medicare and Other Options)”. VITAS Healthcare. https://www.vitas.com/hospice-and-palliative-care-basics/paying-for-hospice/who-pays-for-hospice/