Medicare | Medicaid | Private Insurance | Private Pay
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Who Pays for Hospice and Palliative Care?
Lion Hospice offers comfort care to all terminally ill patients and support to those patients and their families without regard for diagnosis, gender, sexual orientation, national origin, race, creed, disability, age, place of residence or ability to pay.
Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness, and
- You receive care from a Medicare-approved hospice program.
- Please note: ‘Traditional’ Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.
What hospice services does the Medicare Hospice Benefit cover?
Medicare covers these hospice services and pays nearly all of their costs:
- Visits to and services provided by your attending or primary physician
- Nursing care
- Medical equipment (such as wheelchairs or walkers)
- Drugs for symptom control and pain relief
- Short-term inpatient and respite care
- Home health aide and homemaker services
- Physical and other therapies
- Social work services
- Grief support and counseling
What won’t Medicare pay for?
Medicare won’t pay for any of the following:
- Treatment intended to cure your terminal illness
You should talk with your doctor if you are thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time and receive the Medicare coverage you had before you chose hospice care.
- Prescription drugs to cure your illness rather than for symptom control or pain relief. If you are enrolled in Medicare prescription drug coverage, however, drugs unrelated to your illness would be covered (for instance, if you needed medicine to treat an infection unrelated to your terminal illness).
For more information about Medicare prescription drug coverage, visit ww.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227). TTY sers should call 1-877-486-2048.
- Care from any provider that wasn’t set up by the hospice medical team
You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice medical team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. The only time another hospice can care for you is if you are traveling and your hospice program arranges for another hospice to provide short-term care during your trip.
Room and board expenses aren’t covered by Medicare if you get hospice care in your home or if you live in a nursing home, assisted living or a hospice residential facility. However, if the hospice medical team determines that you need short-term inpatient or respite services that they arrange, your stay in the facility is covered. You may be required to pay a small co-payment for the respite stay.
- Care in an emergency room, unless it’s arranged by your hospice medical team
- Care in an inpatient facility, unless it’s arranged by your medical team
- Ambulance transportation, unless it’s arranged by your medical team
In addition to home care, the Medicare and Medicaid Hospice Benefits do cover short-term stays in a hospital, hospice facility and nursing facility. These short stays include respite care of up to five days, and general inpatient care when a person is admitted for pain or symptom management and is discharged when the pain and/or symptoms are under control.
How would care for a condition other than terminal illness be covered by Medicare?
You should continue to use your Medicare plan (such as the Original Medicare Plan or a Medicare Advantage Plan) to get care for any health problems that aren’t related to your terminal illness. You may be able to get this care from the hospice medical team doctor or from your own doctor. The hospice medical team must determine that any other medical care you need that isn’t related to your terminal illness won’t affect your care under the hospice benefit. If you use the Original Medicare Plan, you must pay the deductible and coinsurance amounts. If you use a Medicare Advantage Plan, you must pay the co-payment. You must also continue to pay Medicare premiums, if necessary.
For more information about Medicare health plans, including deductibles, coinsurance, and co-payments, look in your “Medicare & You” handbook (CMS Pub. No. 10050). If you don’t have the “Medicare & You” handbook, you can get a free copy by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can order the handbook online at www.medicare.gov on the web.
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Medicaid is health insurance that helps people who can not afford to pay some or all of their medical bills. Medicaid is available to those individuals that meet the financial eligibility requirements set by their state law. Under Medicaid, like Medicare, there is a Hospice Benefit. The Medicaid Hospice Benefit is an optional benefit that individual States may choose to make available to people in the Medicaid program. 47 States currently have the Medicaid Hospice Benefit.
For the most part, the Medicaid Hospice Benefit covers the same services that the Medicare Hospice Benefit covers. However, there may be some differences, so it will be important for you to ask your hospice provider about the services provided under your state's Medicaid Hospice Benefit.
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Most private health insurance policies have a hospice benefit that includes some or all of the services provided under the Medicare and Medicaid Hospice Benefits. Coverage, co-pays, and eligibility requirements are insurance company specific. Lion Hospice will work with each insurance company toward the best possible plan for the patient.
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Lion Hospice will accept private pay patients as long as they meet the four eligibility criteria. A financial needs assessment will be done at the time of admission to establish the patient's ability to pay. The patient/family will be informed at the time of admission what percentage they will be required to pay. Percentage could range from 0% and 100%.
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Adapted from U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Publication No. CMS 02154. Revised July 2005