Hospice services offer much-needed help to patients with a life-limiting disease and concentrate on the quality of the rest of their lives instead of aggressive treatment. In particular, the issue of who is financially responsible for inpatient hospice care can be critical for many families. Getting some insight into the available financial sources to reduce stress during this period is helpful.
What is inpatient hospice?
Inpatient hospice entails a comprehensive residential setting, such as a dedicated hospice facility, hospital, or nursing home, where patients have round-the-clock care from qualified personnel, including doctors, nurses, and other caregivers. This type of care is often needed when the patient cannot manage symptoms at home or when a caregiver needs a break. Inpatient hospice care provides a structured environment with 24/7 support to promptly meet patients’ needs.
Funding Options for Inpatient Hospice Care
Medicare Hospice Benefit
The Medicare Hospice Benefit, more so the hospice benefit under Part A of Medicare, is the major funder of hospice services in the U.S. It provides both inpatient care and other hospice services for patients who meet the criteria for the program. To qualify for Medicare Hospice benefits:
- The patient must be enrolled in Medicare Part A.
- A doctor and the hospice medical director must determine that the patient is terminally ill and has an expected remaining lifespan of not more than six months if the disease progresses according to its typical course.
- The patient must terminate all treatments to heal in exchange for comfort-oriented care.
Medicare pays all the charges from room and board at a Medicare-approved hospice and all the services related to the patient’s terminal illness. These include medications, medical equipment, counseling, etc.
Medicaid
Medicaid covers hospice services for qualifying low-income earners. Like Medicare, Medicaid reimburses patients for all inpatient hospice services, including shelter and related services. Currently, there are state-specific rules for Medicaid eligibility. Thus, one needs to check the state’s laws. Additionally, some states offer Medicaid hospice waivers for patients who qualify for hospice but do not meet conventional Medicaid requirements..
Private Insurance
Most private insurance plans also include hospice care benefits, most based on the Medicare Hospice Benefit. The definition of coverage can be flexible; thus, it is important to check the policy and see what is described. Sometimes, even persons with private health insurance schemes may have to pay for some co-payments, or the insurance may bear only a part of inpatient care costs. Therefore, the patient or the family should liaise with the insurance company to determine the patient’s insurance status and the costs they will be expected to meet.
Veterans’ Benefits
Hospice care may be available to VHA-eligible veterans and may include inpatient services provided by the VA. Like Medicare, the VA offers a hospice benefit that pays for hospice services in the VA or those in other hospice centers for hire by the VA. Veterans may also be eligible for additional benefits, such as respite care for family caregivers.
Charitable Organizations and Grants
Charitable organizations and grants are very important to those without insurance or those whose insurance only partly covers the expenditure of inpatient hospice care. Some hospices are non-profit organizations that receive funds from various donors, and therefore, they can offer their services to patients who cannot afford to pay for them. National and local organizations, such as the Hospice Foundation of America and the National Hospice Foundation, often provide funding and can guide families to resources to help cover costs.
Planning Ahead
If a loved one is considering hospice care, the process can go most smoothly when it is planned. Specifically, addressing a patient’s financial concerns while formulating the treatment plan can help alleviate future stress. Early consultations with healthcare providers, financial advisors, and hospice organizations are beneficial to ensure patients receive the care they need without added financial worries.
Who Caters to This Inpatient Level of Care Near the End of Life?
If you are an eligible citizen or maybe your loved ones are enrolled in Medicare, you surely know that this program covers many medical services, including extensive hospice care and inpatient hospice care. This part of hospice service is usually called inpatient hospice, and the following question might arise in an individual’s mind.
Does Medicare Cover Inpatient Hospice?
The Medicare Hospice Benefit is a coordinated benefit that provides 100% of the hospice services reported in the hospice plan of care, professional hospice staff, physicians, nurses, social workers/bereavement counselors, spiritual counselors, home health aides, medications, equipment, supplies, and even inpatient care if required. Additionally, Medicare covers four stages of hospice care, one of which is inpatient hospice care, provided specific conditions are met:
- The physician ordered for you by your regular doctor and the hospice medical director confirm that you have a prognosis of six months or less to live.
- It means you agree to receive hospice care instead of care with the focus on treating your illness to be cured.
- You fill out a statement giving up other Medicare benefits that can be utilized to treat your terminal illness and other related ailments to opt for hospice.
Do You Have More Questions About Medicare and Inpatient Hospice Care?
If you have questions about hospice, Medicare, or inpatient hospice care, please contact our nurse care coordinator at 1-888-635-6347. Our team is here to provide guidance and answer any questions. Consultations are available during business hours, and our website offers additional resources and FAQs for further assistance.
FAQs
Does Medicaid pay for hospice care in a hospital?
Yes, Medicaid pays for inpatient hospice treatment in most states for people who fulfill income and eligibility requirements. All medically essential services are covered, however rules may be different in each state. Check the Medicaid rules in your area.
Will private insurance cover hospice care at a hospital?
Many private health insurance policies pay for hospice treatment, even when the patient is in the hospital. But the details of coverage, including co-pays, deductibles, and which hospice providers are covered, can be different. It’s a good idea to read over your insurance policy or talk to your provider.
Are there any charges that you have to pay for inpatient hospice care?
There may not be many out-of-pocket costs, including tiny co-payments for drugs or short-term care. Most of the expenditures are usually covered by Medicare and Medicaid. Some private insurance plans may demand a deductible or co-insurance.
Is it possible for veterans to get hospice treatment in a hospital through the VA?
Yes, veterans who qualify for VA coverage can get hospice care while they are in the hospital through VA hospitals or community hospice providers that the VA has contracts with. The VA provides full end-of-life services that are identical to the Medicare Hospice Benefit.
What happens if the patient doesn’t have health insurance?
For people who don’t have insurance, philanthropic groups, grants, and nonprofit hospices may be able to assist pay for things. The National Hospice Foundation and the Hospice Foundation of America are two groups that can help families with money or point them to other services.
