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How is Hospice Care Paid For?

Who pays for Hospice Austin’s care?

Medicare, Medicaid and most private insurance companies cover hospice care. And, as a nonprofit organization, Hospice Austin provides care to all who need us, regardless of a patient’s disease or ability to pay.

Medicare Coverage of End of Life Care

Medicare is federal government health insurance that guarantees health care coverage for seniors and some younger individuals with disabilities. Working Americans who paid taxes into the program automatically become eligible for Medicare upon turning 65. Part A and Part B of Medicare cover all hospital and doctor care deemed medically necessary. Part B is optional and has a premium.

Medicare also offers a Hospice Benefit. This is intended for individuals 65 or older who have a serious illness and six or fewer months left to live and who agree not to participate in any life-saving or curative treatment. The Medicare Hospice Benefit pays 100% for hospice care services related to a patient’s terminal illness and that are part of the patient’s plan of care.

A summary of Medicare coverage as it relates to potential end-of-life care is detailed below. Not all services covered by Medicare are listed.

Medicare Part A
  • Hospitalization
  • Skilled nursing care
  • Certain in-home health services
Medicare Part B
  • Outpatient services
  • Lab tests
  • Some clinical trials
  • Supplies and medically necessary equipment
Hospice Benefit
  • Care for two 90-day periods and unlimited additional 60-day periods with doctor certification that patient has less than an estimated six months to live
  • Nursing, physician, counselor, medical social worker services
  • Physical therapist, occupational therapist, speech-language pathologist services
  • Aide and homemaker services
  • Medications, medical equipment and supplies related to terminal illness
  • Bereavement services

Medicare Advantage Coverage of End of Life Care

Medicare Advantage is offered to individuals already enrolled in Medicare and is provided by private insurance companies. This option typically adds Part D to Medicare Part A and Part B, giving enrollees prescription drug coverage. Medicare Advantage policies can also cover additional things left out of Medicare Plans A and B. They are a great option for chronically-ill individuals because they can be customized to include treatments for certain conditions that may otherwise be excluded from general Medicare coverage. Common types of Medicare Advantage Plans are Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs).

Medigap Coverage of End of Life Care

Medigap is Medicare supplemental insurance that can help cover costs for things that Medicare does not, such as copays and deductibles. Medigap typically requires enrollment in Medicare Part A and Part B and prohibits simultaneous enrollment in Medicare Advantage plans. Medigap plans require a premium payment to a Medigap insurance company alongside Medicare Part B premiums. However, both plans work simultaneously to cover health care costs.

Medicaid Coverage of End of Life Care

Medicaid is needs-based health insurance provided by both the state and the federal government. The disabled, those receiving Supplemental Security Income, and others with a qualifying financial need can receive Medicaid coverage as long as they are residents of the state giving them benefits and US citizens, with some exceptions. The Medicaid Hospice Benefit is similar to the Medicare Hospice Benefit in that it covers 100% of the care related to . If these individuals utilize the services of Medicaid-certified providers, Medicaid pays for most of their health and long-term care. Seniors receiving Medicare may also qualify for Medicaid if they cannot afford the premiums or deductibles for their Medicare coverage.

Following is a summary of Medicaid coverage as it relates to end-of-life care. Not all services covered by Medicaid are listed.

General Medicaid
  • Laboratory services
  • Inpatient and outpatient hospital services
  • Physician services
  • Skilled nursing facility services
  • Some in-home health care services
  • Prescription drugs
Hospice Benefit
  • Nursing, physician, counseling, and medical social services
  • Short-term inpatient care
  • Home health aide and homemaker services
  • Physical therapy, occupational therapy, and speech-language pathology services
  • Medications, medical equipment and supplies related to terminal illness
  • At least 95% of room and board costs for nursing homes

Hospice and Palliative Care Benefits for Veterans

Hospice and palliative care are covered by the VA as part of the VHA Standard Medical Benefits Package. Both are available to qualifying veterans who are a part of the VA healthcare system.

VA Hospice Care

All enrolled veterans who meet the clinical need requirement are eligible for inpatient, outpatient, or in-home hospice care. There are no copays for hospice care provided by the VA or by contracted service providers.

VA Hospice Care Services Include:

  • Services that control symptoms and relieve suffering
  • Bereavement support for the family

VA Palliative Care

Enrolled veterans are eligible for palliative care if they meet the clinical need requirement for services. Copays may be required.

VA Palliative Care Services Include:

  • Care by a health team, including a medical provider, social worker, nurse, chaplain, mental health provider, and others
  • Professional help identifying and providing care for physical and emotional symptoms
  • Family support services
  • Referrals and consults with primary care physicians or specialists

Additional VA Resources

Veterans Health Administration
Veterans Health Administration
Veterans Health Administration
Veterans Health Administration
Military Benefits
Veterans Health Administration
Veterans Health Administration

This information is reprinted with permission from Caring.org, a website devoted to family caregivers. You can find more information for caregivers on their site here. If you have questions about hospice coverage, please call us at 512-342-4700.

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