Paying for hospice care is a concern for many families in Virginia Beach, but the vast majority are pleased to learn that their worry is unwarranted.
When an aging relative is diagnosed with an advanced illness, looking into hospice care is a logical step. In essence, the objective of hospice is to provide comfort and peace of mind at the end of life, and that’s what we all want for our loved ones.
But who pays for hospice care? Actually, for eligible individuals with traditional Medicare, services are available at no cost. If the patient has a Medicare Advantage Plan that covers hospice care, there could be a copay. Since Medicaid models their coverage after the Medicare hospice benefit, very few Virginia Beach families end up shouldering the financial burden.
Who Qualifies for Medicare-Covered Hospice Care?
To be eligible for the Medicare hospice benefit, an individual must meet the following criteria:
- Enrolled in Medicare Part A
- Certified as terminally ill by a doctor
- Expected to live six months or less
- Prepared to stop curative efforts
In addition, Medicare pays for hospice care only when services are provided by a Medicare-approved hospice agency. That’s also true for patients with Medicaid, and for those who are dual-eligible, Medicaid can cover costs that Medicare doesn’t.
Does Medicare Cover In-Home Hospice Care Services?
For anyone who is meets the eligibility requirements for hospice care, Medicare and Medicaid both offer coverage for in-home services.
As defined by the Centers for Medicare and Medicaid Services (CMS), four levels of hospice care are available:
- Routine home care, also called hospice care at home, with services provided in wherever the individual resides
- Continuous home care, involving around-the-clock nursing support or the purpose of addressing a medical crisis
- In-patient care, provided at a local hospital or Virginia Beach hospice facility when in-home care is not a viable option
- Respite care, a temporary transfer to in-patient care for the purpose of giving family caregivers a break
Some Virginia Beach patients experience all four levels of care within a short period of time, while others receive routine home care for several months. In any case, the costs are covered.
What Hospice Services Does Medicare Cover?
The hospice coverage provided by Medicare and Medicaid covers a broad range of services. Patients with benefits through either program may not have to pay for any end-of-life services related to their terminal diagnosis.
Care plans are customized to meet the unique needs of each terminally ill individual, but Medicaid- and Medicare-approved hospice agencies in Virginia Beach are equipped to provide:
- Medical and nursing care
- Pain and symptom management
- Prescription medication
- Durable medical equipment
- Medical appliances and supplies
- Physical and occupational therapy
- Speech-language pathology services
- Special services, like pet therapy or massage
- Nutritional and dietary counseling
- Emotional and spiritual support
- Social worker and hospice aide services
The Medicare benefit covers end-of-life services designed to improve patient comfort, and support is also provided to the individual’s loved ones. Families of Virginia Beach patients can take advantage of:
- Helpful information and care guidance
- Connections with community resources
- Volunteer support and companionship
- Assistance at the time of the patient’s death
- Grief counseling and bereavement services
While the costs associated with all of the services listed above are covered, Medicare and Medicaid beneficiaries who elect to enter hospice may face some expenses. However, that’s only the case when a patient pursues non-covered services. Neither Medicare nor Medicaid offers coverage for:
- Any medical treatment, therapy or medication intended to provide a cure instead of providing pain or symptom relief
- Any services not arranged for or provided by the hospice team, including ambulance transportation and emergency care
- Medicaid covers Room and Board for patients that meet the Long Term Care Requirements for the benefit.
How Long Does Medicare Pay for Hospice Care?
Hospice care is only covered by Medicare and Medicaid when an individual is terminally ill and has six months or less to live, assuming their illness runs the usual course. But, this doesn’t mean that services are only available for six months.
If a patient happens to live longer, they can be recertified for hospice, without a break in services. The Medicare benefit allows for two 90-day periods of care followed by an unlimited number of 60-day periods. As long as the terminal illness remains and a doctor still believes the patient’s prognosis to be six months or less, all necessary services will continue to be covered.
Conversely, if an individual’s illness goes into remission and a doctor determines they no longer have a limited prognosis, coverage for hospice services — whether through Medicare or Medicaid – comes to an end. And, patients can always choose to leave hospice and once again receive curative treatment. In either situation, returning to hospice care is an option, provided the individual meets the requirements.
Who Pays for Hospice When a Patient Doesn’t Have Medicare?
For terminally ill individuals who don’t qualify for Medicare or Medicaid coverage, the costs of hospice care may be covered by private health insurance or a managed care plan. Those who aren’t insured can ask a local hospice agency about payment assistance options – most have specialists on staff who are familiar with the resources available and can point patients toward an affordable solution.
The professional team at Suncrest, a leading Virginia Beach hospice agency, understands the Medicare benefit and Medicaid coverage, and we’re happy to answer your questions about paying for hospice care. For more information, contact us today!
