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Summary

Hospice care is nowhere near as expensive as care in a nursing home or a hospital.

Medicare, Medicaid, private health insurance and other types of health insurance generally cover hospice care. If you have health insurance but it does not pay for hospice care,  there are steps to take to try to convince the insurer to pay.

If you have to pay, free hospice care is generally available.

How Much Does Hospice Care Cost?

The cost of hospice care is generally much less expensive  than that of traditional healthcare treatment facilities because 90% of hospice  care is provided in the home and is primarily administered by family and loved  ones. 

According to the American Hospital Association, an average day in a hospital in 2004 cost $7,353, while insurers paid hospice programs about $120 a day per patient for most care.

The amount you pay for hospice care can vary depending upon:

  •  
    • Your insurance coverage  
    • The length of treatment, and  
    • Type and extent of services that you require.

Private Insurance and Hospice Care

Because hospice care is typically much less expensive than hospital treatment, most insurance providers cover the cost of hospice care. Some managed care plans may require that you use a hospice facility with which they contract. 

Check your plan and look for words such as "hospice" "end of life care" or "palliative care". If you have quetions, contact your benefits administrator or your case manager at the insurer for the specific details, including coverage for home health care. 

Continuing medical treatment of the health condition is known as "curative treatment" even if the condition is expected to be terminal. Some hospices and insurance companies do not permit curative care for someone who has entered hospice. Others do. If the policy permits curative treatment, it is generally paid for under the policy's regular medical benefit, while the traditional hospice care is paid as a hospice benefit.  If you pay a 20% co-insurance for health care, but 0% for hospice care, the 20% co-insurance would apply to the curative treatment (but not to the hospice care).

If your policy has a limit on hospice care expense, and you start to get close to the limit, look for other areas of the health insurance that would help pay for hospice care. .

Medicare And Hospice Coverage

The following discussion is about Original Medicare. The coverage for Medicare Advantage policies depends on the terms of each policy. To learn more about Medicare  Advantage policies, see Private  Insurance, above.

What is necessary before Medicare covers hospice care

If you qualify for Medicare Part A, you will be covered for the costs of hospice if:

  • The hospice organization has a Medicare approved hospice program. Approximately 80% of hospice organizations have the necessary certification.  
  • You have certification from your doctor that you are terminally ill and probably have less than six months to live if your illness runs its normal course. A revision of the rules in 2000 made it easier for doctors to refer patients to hospice. Before the change, doctors had to be  fairly certain of a life expectancy of six months or less. The Wall Street Journal describes the current state of the time frame as " more of a loose estimate." 
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. 

Medicare provides care for two 90-day periods followed by an  unlimited number of 60-day periods.  At  the start of each period of care, in order for coverage to continue, your  doctor must re-certify that you are terminally ill. Even if you live longer  than six months, you can continue to get hospice  care as long as your doctor re-certifies that you are terminally ill.

Hospice services and supplies Medicare covers

Medicare covers nearly all of the costs associated with hospice care, including the following:

  • Doctor services.
  • Nursing care. 
  • Medical equipment (such as wheel chairs and  walkers). 
  • Medical supplies.  
  • Medications for pain management and control of  symptoms such as nausea, vomiting, and diarrhea. 
  • Short-term  hospital care, as needed for pain and symptom management. 
  • Respite Care to give your family caregivers a break in their duties. You may stay in a Medicare approved hospital, private hospice facility, or nursing home, up to 5 days at a time.   
  • Home health aide services. 
  • Homemaker services. 
  • Physical and occupational therapy. 
  • Speech therapy. 
  • Social worker services. 
  • Nutritional counseling. 
  • Mental health counseling for hospice patients  and their family. 
  • Regular Medicare benefits are available to treat  medical conditions unrelated to the terminal illness. 
  • Grief and loss counseling for you and your  family.

Medicare also pays for:

  • Covered  benefits for any health problems that aren't related to your terminal illness. 
  • A  one-time-only consultation with a hospice medical director or doctor to discuss  your care options and management of pain and symptoms. You don't have to choose  hospice care for this consultation to be covered.

You Pay:

  • Prescription  Drugs:
    • The hospice is allowed to charge 5% of the reasonable cost up to $5.00 per prescription for outpatient drugs (those used in the home) for pain management and symptom control. The costs of these medications are covered in full when provided on an inpatient hospice basis.
    • Medicare Parts A and B do not pay for prescription drugs to cure your illness rather than for symptom control or pain relief. They may be covered separately if you are enrolled in a Medicare prescription drug coverage plan.    
  • Respite Care: If you go into a hospital or other facility to give your  caregivers a break, currently you can only be charged a maximum of 5% of the total Medicare pays for respite care in that facility. (The amount can vary from year to year). The average out of pocket expense is about $5.00 a day, but can vary depending upon geographical location. 
  • Room and board at home or in a nursing home or hospice residential facility except if the hospice medical team determines that you need short term in-patient or respite services. 
  • Care in an emergency room, in-patient facility, or ambulance unless arranged by your hospice medical team. 
  • Treatment to cure your terminal illness, though you can stop respite care and have such costs covered.

Champus / Tricare And Hospice Coverage

Hospice care is covered for all military personnel and their dependents through this program. 

Before Champus/Tricare pays, the hospice agency must be Medicare certified.   

The services provided, and reimbursement for those services is the same as those for Medicare.  For more details see www.tricare.osd.mil offsite link 

To Learn More

Medicaid And Hospice Coverage

Medicaid coverage is administered individually by each state and the services covered under hospice care may vary.

All states provide coverage for hospice care through Medicaid except: Connecticut, Louisiana, Maine (in which coverage is pending), Nebraska, New Hampshire, Oklahoma and South Dakota.   

Medicare must certify hospice organizations in order to receive Medicaid coverage.   

To determine the services covered in your state, contact your state hospice organization or state Medicaid office. To locate your state's office, see: http://64.82.65.67/medicaid/states.html
offsite link

Private Pay For Hospice Care

  • If you have no medical insurance coverage, you can pay for hospice care yourself.  
  • Depending on your financial situation, the hospice may provide services based on a sliding scale fee. Free hospice care is available. (See the next section)

Low Cost Or Free Hospice Care If Money Is An Issue

If finances are a problem, a hospice may provide services based on a sliding scale fee. 

Many hospice programs will provide their services free of charge if you have very limited or no financial resources. These costs are usually paid for by private donations.

Steps To Take To Convince An Insurance Company To Pay For Hospice Care

If you have health insurance that covers hospital care for your condition, and your policy does not pay for hospice care where you want it, consider the following steps which are aimed at convincing the insurance company that it will save money if you receive hospice care.

Step 1. Contact a family member or friend who is good at negotiating and who understands business principles.

Step 2. If the person agrees to help, write a letter stating that the person is authorized to contact the insurer on your behalf and that you authorize the person to discuss confidential medical information under HIPAA (the federal medical privacy law.) 

Step 3. He or she should gather the financial facts - namely, what it would cost if you were treated in a hospital instead in a hospice situation, and what it will cost for you to be treated in a hospice situation. It would also help the argument if your doctor would write a letter to the effect that if you are not given hospice care, then it is a medical necessity for you to be in the hospital. 

Step 4. Ask the person to then contact the insurer on your behalf.

  • He or she should ask to speak with a supervisor who has authority to make a decision about coverage payment. If all else fails, he or she can contact the President's office. While it is unlikely the president will get involved in the situation, a referral from his or her assistant will be taken seriously by the person who ultimately takes the call.
  • The request should be for a payment of a daily amount rather than on a fee-for-service basis. Fee for service does not generally pay for social workers, chaplain visits, volunteers and grief counselors.