Hospice care is a valuable resource for those with a life-limiting diagnosis, but is it affordable? Learn about coverage options here.
When someone has a life-limiting diagnosis, their doctor may refer them for hospice care, a care model that helps to improve a patient’s quality of life at the end of life. But many times, patients and families are unsure about who is eligible for the program and how they will be able to afford the many benefits.
Hospice care is covered by many health insurance plans, so it’s more within reach for the average person than most people realize.
“I wouldn’t want people to make assumptions that could hinder their health or their ability to feel the best that they possibly can feel under their circumstances,” says Letizia Cinelli, director of financial operations for Northwell Health’s Hospice Care Network. “Even if you think that you can’t afford it, there’s no harm in asking. We can have a conversation about it."
Before you think about the financial costs, however, it may help to first understand just what hospice is—and who it’s for.
Hospice care is typically offered to patients when life-prolonging medical treatments are unavailable, or when such treatments would cause more harm than benefit. Patients typically live at home for their final days, weeks, or months, while a multidisciplinary team of providers manages their symptoms and helps to keep them comfortable. This care enables patients to spend meaningful time with loved ones, instead of making repeated trips to the emergency room. But beyond that, patients’ relatives also receive support from the hospice care team, which makes it less stressful to be a family caregiver for someone who’s at the end of life.
“I see firsthand what it can do for the patient and the family,” Cinelli says. “It’s really about supporting and managing the patient’s symptoms. They’ve lived their whole life, and now they’re at the point where supportive care is needed the most. I want people to experience the hospice benefit.”
Determining hospice care coverage
When a patient is referred for hospice care, the program’s revenue cycle department receives their health insurance information to see if the benefit is covered. In many cases, it is.
“If they have fee-for-service straight Medicare, all hospice services and all medications that are related to the hospice, all the durable medical equipment, all the nursing visits, will be covered at 100%, and there is no out-of-pocket for the patient,” Cinelli says. “It’s the same for the straight, fee-for-service Medicaid. But when you go into commercial plans or managed Medicaid plans that may not be the case.”
For private health insurance plans or Medicaid Managed Care, hospice care coverage varies by the individual plan. Patients may have copayments, deductibles, or coinsurance. Before a patient is onboarded, someone from the hospice’s revenue cycle department should contact the patient or a family member to let them know about the financial details.
“If you have $1,000 deductible, for example, someone will call to walk through that with you,” Cinelli says. “That way, you know what’s coming down the pike, and you’re not shocked when you get a bill from us.”
Some people without health insurance may qualify for hospice as charity-care patients. The hospice program works with individual patients to determine what they are able to afford.
Hospice care covers many services
Every patient who qualifies for hospice care receives the same benefits, regardless of the type of insurance that they have. Prescription medications are covered. Durable medical equipment, including hospital beds, are sent to the patient’s home. Health care providers, social workers, chaplains, and volunteers visit the patient at home.
“Whatever they receive in a hospital setting, they will receive at home,” says Cinelli, who notes that a hospice patient’s home can be “an assisted living, a nursing home, or your home residence.”
Family caregivers can also receive respite care and, later, bereavement services, through hospice.
All hospice benefits are covered for each patient, as determined during the onboarding process; there are no additional fees.
“If it’s related to hospice and the benefit and the services that we provide, there’s no hidden anything,” Cinelli says.
However, patients or their families may be responsible for certain services that are not included within hospice care. For example, if a hospitalized patient signs on for at-home hospice care, the benefits don’t begin until the patient actually arrives at home.
“The ambulance ride from the hospital to home will not be covered by hospice,” Cinelli says. “The patient is not our patient until they reach the home.”
Still, some families want around-the-clock care for their loved one—which is one service hospice doesn’t provide. But if you can afford to pay out-of-pocket for a constant companion for yourself or a loved one in hospice, you can privately hire a nurse or home health aide to supplement hospice services.
Many patients who are referred for hospice care aren’t in a position to pay for additional services like this; rather, they may wonder whether they can afford hospice care at all.
If a doctor refers you or a loved one for hospice care, have a conversation with someone at the facility to see if health insurance will cover the benefit.
“Don’t let something like financial responsibility or financial questions deter you,” Cinelli says. “Just call us. The call won’t cost you anything. We’ll let you know if hospice is right for your loved one or you … We’re here to help. And we want to help you.”