Frequently Asked Questions (FAQs) about Paying for Hospice

• You receive care from a Medicare-certified hospice
• Your attending physician (if you have one) and the hospice physician certifies you as terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course
• You sign an election statement to elect the hospice benefit and waive all rights to Medicare payments for the terminal illness and related conditions

Medicaid provides hospice coverage, but it varies by state. Medicaid beneficiaries should check with their state Medicaid agency and state hospice association for specifics about what services are covered.

Medicare coverage includes:*

• All items and services needed for pain relief and symptom management
• Medical, nursing, and social services
• Drugs for pain management
• Durable medical equipment for pain relief and symptom management
• Aide and homemaker services
• Other covered services you need to manage your pain and other symptoms, as well as spiritual and grief counseling for you and your family

Patients with a private or employer-provided health plan should check with their insurance provider for details about hospice eligibility, coverage and out-of-pocket expenses.

Hospice is a covered benefit for all enrolled veterans. VITAS accepts VA, Medicare, Medicaid, Medi-Cal, and Tri-Care up to 100% payment for hospice services. Veterans generally have no out-of-pocket expenses for hospice-related services.

*Source: Centers for Medicare & Medicare Services. Hospice Coverage. Available at: https://www.medicare.gov/coverage/hospice-care

Both inpatient care and respite care are short-term options.

If the hospice care team determines that your symptoms cannot be managed in your primary residence, or if your usual caregiver needs respite, you may receive inpatient care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you.

For respite care, you can stay up to 5 days each time you get respite care. You may receive respite care more than once, but only on an occasional basis. Per the Medicare hospice benefit, you may have to pay 5% of the Medicare-approved amount for inpatient respite care.

A Medicare or Medicaid beneficiary who resides in a skilled nursing facility may elect the hospice benefit if:*

• The residential care is paid by the beneficiary
• The beneficiary is eligible for Medicaid and the facility is being reimbursed for the beneficiary’s care by Medicaid
• The hospice and the nursing facility have a written agreement under which the hospice takes full responsibility for the professional management of the patient’s hospice care and the facility agrees to provide room and board to the patient

*Source: Centers for Medicare & Medicare Services. Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice Services Under Hospital Insurance Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf

If you don’t have insurance coverage, the hospice admissions staff will work with you to determine financial responsibility and self-payments and to find out if you are eligible for other benefits that could help pay for services.

Note, a small percentage of patients may receive both hospice services and services for an unrelated diagnosis from the Medicare Advantage Plan in some cases, please inquire with your plan if hospice services are included in your benefits.

What you pay for these services depends on your plan and comply with its rules (for example, seeing in-network providers). If your Medicare Advantage Plan covers extra services that Original Medicare does not cover (for example, dental and vision benefits), your plan will continue to cover those extra services if you continue to pay your plan’s premiums and other costs.

Source: Centers for Medicare & Medicare Services. Medicare Hospice Benefits. Available at: https://www.medicare.gov/Pubs/pdf/02154-medicare-hospice-benefits.pdf

There are no cost associated with hospice consultations or evaluations.