Who Pays for Hospice Care at Home? Can Insurance Help?
Who pays for hospice care at home? Will private insurance cover home hospice? Will Medicare or Medicaid cover costs? Are there any other options?
Who Pays for Hospice Care at Home?
When a family is facing the looming death of a loved one, practical considerations can add immense stress to an already grief-filled situation. Terminally ill people need exceptional care to maintain a good quality of life, but if the family is wracked with worry about supposed hospice costs, theit ill loved one may not receive timely care. Many know that hospice care is covered by benefits, but they don’t know where. Who pays for hospice care at home? Are the costs different in a nursing home or a hospital?
Many people wrestle with these questions, which is a tragedy; nobody who is so unwell should go without care due to costs, and family members have better things to worry about than finances.
Hospice certainly looks costly. A hospice team can be large: doctors, nurses, health aides, therapists, chaplains, and social workers. Then there is the cost of medicine and equipment to consider. When a loved one needs hospice care, the costs, real or imagined, can cause delays in setting up proper care for the patient. And the additional consideration about where to put a loved one in hospice can cause further delays.
If you or a loved one needs hospice care, don’t delay; too many people express regret for not getting their loved one in a hospice program sooner. There are a great number of ways to fund hospice care without paying for it out of pocket. National and state programs, private insurance, and sometimes even the generosity of strangers can pay for hospice care, partly or entirely.
Many people assume that Medicare or insurance benefits for hospice have some extra costs or limitations for hospice patients staying at home. This is not the case. Hospice is a service, not a place, and it can take place equally well in someone’s home, in a nursing home, in a dedicated hospice facility, or in a hospital.
Medicare will cover almost all hospice treatments at home or elsewhere. But to qualify for the hospice benefit, the patient must meet a few requirements: she must be 65 or older; her regular doctor and a hospice doctor must certify that she has six months or less to live; she must accept that treatment will be only for her comfort, not for curing the illness; and she must sign a statement expressly demonstrating her wish for hospice care.
If she meets those requirements, then hospice care can begin; there is no deductible to pay. The Medicare hospice benefit will cover the costs of the staff: doctors, nurses, home health aides, therapists, chaplains, social workers, and many others besides. Even after the patient has passed away, family members can avail themselves of bereavement care covered by the Medicare benefit. The benefit will also cover equipment and medicine costs. However, you must receive all services and treatments from a Medicare-approved hospice provider: if you wish to engage a caregiver from outside your provider, you will have to pay for it through some other means. This includes hospital emergency room visits and ambulance transportation if they are not arranged by the hospice provider.
There are a few other costs that the Medicare hospice benefit won’t cover. You might need to provide a $5 copayment for each prescription the patient needs. One service available to family caregivers is inpatient respite care, in which the patient is cared for at a hospice facility for up to five days, allowing the family some time to rest. Medicare covers most of the inpatient costs, but the family will be responsible for 5% of the Medicare-approved amount for that stay.
Medicare will still pay for treatments not related to the terminal disease. For example, if a terminally ill patient is dying from lung cancer and also has diabetes, Medicare will cover the cost of his insulin. In these circumstances, however, the patient will still be responsible for copays and deductibles.
Medicare will also not pay for room and board if hospice is taking place in a nursing home or other care facility, except for inpatient respite stays as mentioned above. Nor will Medicare assist with home costs if the patient resides in a home hospice.
Every hospice provider, for each patient, must produce a list of treatments and medications that are not related to the patient’s illness, and thus, are not covered by hospice benefits. This list is available by request, and it must include reasons why the treatment is not included. If you think some treatment might help the patient, call the hospice provider and ask about it; maybe they can bring it to your home.
For low-income families, Medicaid can provide hospice benefits. Each state has different eligibility requirements for Medicaid; usually, as with Medicare, the patient has to have six months or less to live and elect for comfort care rather than curative treatment. There are income limits as well; they often change from year to year as a function of the poverty level.
California’s version of Medicaid is called Medi-Cal. Medi-Cal is available for low-income families (income cutoff is dependent on the size of the family and is based on 138% of the poverty level) but is also available for people over 65 and for those with certain disabilities. In terms of services offered, it is quite similar to Medicare.
Almost all private or workplace insurance includes some kind of hospice benefit. Usually, private insurance will model their range and scope of benefits on Medicare’s offerings, but every policy is different. If you have private insurance and need hospice benefits, check with your insurance provider to see how they can help.
Getting Outside Help
An overwhelmed family of caregivers, too exhausted to do laundry and perform housekeeping, might hire a maid service to help keep their home in shape. Unfortunately, no insurance or government program will fund that expense (but some charitable organizations staffed by volunteers might help for little or no expense).
As mentioned above, Medicare will cover the cost of personnel only from approved providers. Medicaid and insurance have approved providers as well. This does not mean that you cannot obtain help from elsewhere, but you will probably have to pay out of pocket. For patients and families that want additional professional care, this might be a worthwhile cost.
One example of such a professional that has emerged in recent years is the concierge physician. These are doctors that one pays a monthly or yearly fee to keep, essentially, on retainer. The payer gets multiple benefits: short wait times, direct email and phone consultation at need, and most importantly for in-home hospice patients, house calls. There are concierge doctors who specialize in geriatric and hospice medicine, giving hospice patients top-notch care on demand.
The funding of concierge doctors varies depending on the service used. Some accept no insurance or Medicare; the retainer fee covers the costs of basic services, but lab work, x-rays, and other such procedures bear extra costs. Other concierge services charge as much as they can to Medicare or private insurance, but the retainer fee ensures close contact with one’s doctor.
Regardless of their stance on insurance and Medicare, concierge healthcare services are not inexpensive. The most basic care might cost $1,500 a year plus fees, whereas highly specialized services might reach as high as $20,000 a year.
Other Benefits Available
Who pays for hospice care at home if nobody can afford it? Medicare or insurance might cover the great majority of hospice costs for the patient, but that doesn’t mean that family members won’t experience financial burdens.
In home hospice, family members do most of the work in caring for their ill loved one; family members truly are the center of the hospice team, and family takes on most of the labor and emotional burden of caring for the terminally ill patient. Really, the efforts of the rest of the team are to help the family keep the patient comfortable.
All this work on the part of the family implies a financial burden. At the very least, a family member in the role of caregiver will not be able to work much and earn wages. But the family member still must pay for utilities and other home costs, small items to entertain and please the patient, and, probably, ample take-out since everybody will be too exhausted to cook.
Being a family caregiver is an expensive commitment. Many who take on the role stop saving money; others go further into debt to provide for the ill loved one. This is a growing concern in the United States, with its aging population.
A few states have implemented, or will soon implement, paid family leave laws designed to help family caregivers. California was the first state to enact such a law, launching it in 2005. In California, qualified employees can earn 60% to 70% of their weekly earnings (up to $1,300 a week) for up to eight weeks.
If you’re working, check with your state government website and your company’s human resources personnel to see if family leave is an option for you.
All veterans, except those discharged dishonorably, are eligible to receive hospice benefits from Veterans Affairs. It has similar eligibility requirements as Medicare’s hospice benefits: 65 or older person with less than six months to live. Veterans Affairs partners with hospice care providers across the country to provide excellent care for veterans nearing their end of life.
Veterans and their caregivers are also eligible for a variety of other benefits. Pensions, funeral benefits, compensation benefits for disabilities acquire while serving, survivors’ benefits for dependents and spouses, and much else might be available.
There are several aid programs for veterans not explicitly made for hospice care but can often be claimed by veterans in hospice and their families.
Veterans who meet certain criteria can receive the Aid and Attendance benefit to help cover the cost of a caregiver, who can be a family member. Alternately, housebound veterans can obtain a supplement to their pensions.
There is also the Program of Comprehensive Assistance for Family Caregivers. The Program provides monthly stipends to family caregivers of veterans who were injured or sickened in the line of duty.
The benefits due to veterans can be a difficult issue to sort out. There are many variables to account for: where the veteran lives, the time, place, and nature of the veteran’s service, if the veteran was disabled or made ill by his service, and much else besides. Hospice social workers are well-informed about such intricate matters and can help terminally ill veterans secure all the benefits due to them. They can also help veterans obtain the honor and recognition due to them by obtaining discharge papers and replacing lost medals. If the patient wishes, the social worker can have him included in an upcoming veterans ceremony to recognize and salute his service.
Those without insurance, Medicare, or private means of paying for hospice should not give up hope of excellent care for their terminally ill loved one. Hospice workers are, as a whole, selfless and generous people, and one of the core tenets of hospice care is that everyone deserves care during the end of life. For these reasons, many hospices offer care at a reduced rate—even for no cost at all—for people with low income. Grants, foundation revenue, and donations from corporations and private citizens provide the means of offering this service.
People without other means should call their local hospice providers to see if such help is available. Hospices often have financial experts who can help price hospice services within the means of low-income families. If this is your situation, do not delay calling for help.
How a Social Worker Can Help
Hospice social workers are deeply knowledgeable in many fields. They are experts in managing the labyrinths of insurance paperwork and medical billing. A dedicated social worker will help families understand just what is covered by Medicare, Medicaid, or insurance, and can help track down any benefits that might be due to the patient.
Social workers are also well-versed in legal matters. They can help a patient write a will and advance directives, ensuring that the patient’s desires are respected and affairs are in order.
If there is financial assistance available that the family might make use of, the social worker will know of it and help to secure it. And finally, social workers often fill the role of counselor. Between helping out with paperwork and Medicare billing, the hospice social worker will look after the emotional needs of the family. For just about anything you might need, the hospice social worker can help.
Unique Care Los Angeles Hospice