Hospice Coverage Options

Original Medicare does cover hospice care with certain limitations. To receive benefits, patients must meet the following criteria:

• They get care from a Medicare-certified hospice
• Their attending physician (if they have one) and the hospice physician certify them as terminally ill, with a medical prognosis of 6 months or less to live
• They sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions

Medicare will cover hospice care services but won’t pay for the cost of an assisted living facility or a nursing home’s room and board.

While using the Medicare Hospice Benefit (it is an insurance benefit), any services that are related to the terminal diagnosis and related conditions are covered by the hospice. If you desire any services in addition to what Medicare or Medicaid would normally cover – discuss those with your hospice provider prior to seeking, i.e., procedures, doctor visits, therapy appointments.

If you have a Medicare Advantage plan, your coverage may vary depending on your insurance company and policy.

Medicaid typically covers hospice treatment. If you meet the income and asset limits, you could qualify for assistance paying for room and board. The care and services mirror the Hospice Medicare Benefit such as all levels of care (Routine, Respite, General Inpatient and Continuous Home Care), medical supplies, equipment and medications.

Whether hospice is covered by insurance varies depending on what type of insurance coverage you have and whether you qualify for other forms of financial assistance. For example, while group insurance plans often cover hospice care, not all of them do. It’s important to ask your insurance provider what is and isn’t covered.

Under most circumstances, some services are covered while others aren’t. An insurance plan might cover the cost of medicines, supplies,medical equipment and hospice care but require you to pay for room and board at an inpatient facility. 

It’s a good idea to review your insurance plan’s details so you know what your out-of-pocket expenses will be before you receive care. This ensures you’re able to plan ahead financially.

If you don’t have insurance coverage, you may wonder if you’re able to pay for hospice care on your own..

 Speak with the hospice and get a better understanding of the services Three Oaks or another hospice would be providing. Three Oaks is here to help and we can work with families on services and setting up payment plans.

If you do qualify for coverage through your private insurance company, the covered services can include comfort care, routine home care, durable medical equipment, medical supplies, prescription medications and care at an inpatient facility when deemed necessary. 

Private insurance may have an inpatient hospital deductible that must be met before the insurance company begins to cover services. The hospice benefit includes any inpatient respite care that’s needed for the terminally ill patient when there’s a caregiver.

If your insurance covers hospice care, you may need to check to see if you’re required to receive care inside the insurance company’s network. Some providers may only accept some insurance plans, so you should ask your potential hospice care provider which insurance plans they work with during your search for care.