One of the decisions 52-year-old Jerry had to make after receiving a diagnosis of terminal cancer was whether to use the services of a hospice program. He already knew he’d welcome this type of care when the time was right. Unfortunately, what he had to decide was whether he could afford it.
Hospice care has grown so rapidly across the Untied States within the last 30 years that most Americans just assume that if they need it, insurers or the Federal government will make it available to them. However, this is partially a misconception.
According to the American Cancer Society, there are four ways to pay for hospice care:
Private insurance
Most but not all health care insurance policies include some hospice care among their benefits. Patients and their families should be sure to review any policies to see what they might cover and should also verify that benefits include home care.
If the benefits information isn’t clear, a call or letter to the insurance company either through an employer’s human relations department or directly to the insurer will be necessary.
Federal programs
Medicare, Medicaid in some states, and the Department of Veterans Affairs provide benefits for hospice care.
Medicare. In order for a patient to use the Medicare hospice program, a doctor and a hospice medical director must certify that he or she has less than six months to live, assuming the medical condition runs its normal course. The physician needs to recertify the patient at the beginning of each benefit period. Patients are covered under 2 periods that are each 90 days long, followed by an unlimited number of 60-day periods.
The patient must sign a statement that shows an understanding of the nature of the illness and what hospice care entails. He or she also needs to indicate a desire to be admitted to the hospice. This in effect means that the patient is declining Medicare Part A and is opting for the Medicare hospice benefit for all care related to the illness. If he or she is unable to sign, a family member may do so. Medicare benefits will still be available for other conditions.
In order to get a provider of hospice services paid by Medicare, the agency must be on the local list Medicare has approved for those services.
Medicaid. Thanks to a 1986 law that allowed the states to develop coverage for hospice programs, most – but not all – of them offer a Medicaid hospice benefit. Its structure is similar to that of the Medicare hospice benefit.
Department of Veterans Affairs. Around 85 percent of American veterans who die each year receive no end-of-life benefits from the Department of Veterans Affairs (VA). Yet for vets enrolled in the Veterans Health Administration (VHA) program, hospice care is part of the basic eligibility package. If these services have been deemed appropriate for the veteran and funding from other programs isn’t available, they will be provided either at VA medical centers or through community hospice agency services the VA purchases. A complete toolkit explaining the coverage is available at the VA site.
Patient expenditures
Even if a patient receives benefits from one or more of the above sources, they will almost never completely cover the cost of hospice care. Providers or their families will need to pay providers directly for any non-covered services.
According to Caring.com, since the cost of hospice care depends on the duration and types of services a patient needs, home care is often less costly than end-of-life treatment in a hospital because of the use of fewer types of technical equipment. However, hospice care costs beyond paid benefits often runs into the thousands of dollars if it lasts more than a few months. Medicare currently pays the majority of hospice care bills for individuals covered by the program. In addition to Medicaid and VA programs, Caring.com cites the Civilian Health and Medical Program of the Uniformed Services and the Indian Health Services as sources of some benefits.
Patients and their families who are unable to pay for hospice care should look for community resources to help. Typically, these are from church and religious groups and include both volunteer services and financial assistance. It’s also sometimes possible to negotiate with hospice care providers for reduced fees due to financial circumstances.