Consumers: What is the Cost of Hospice Care, and Who Pays For It?
Reimbursement for hospice services comes from Medicare, Medicaid, health maintenance organizations, and other private insurance plans. Under Medicare and Medicaid in Colorado, all the services provided by the hospice team, medical equipment such as hospital beds, and pharmaceuticals related to the terminal illness are fully covered (although hospices may collect a very low co-payment for pharmaceuticals). Questions about the nature of the hospice benefit available in a particular insurance plan should be directed to the insurer or to a hospice representative.
Hospice services are available under the regular Medicare benefit. In 1983, Congress expanded the Medicare insurance program to include hospice care. To be eligible for this benefit, a physician must state in writing that, in his or her clinical judgment, the patient has less than six months to live if the disease runs its normal course. The physician must review the medical chart and restate his or her belief that the individual has less than six months to live at certain intervals, known as "benefit periods" (two periods of 90 days each, followed by an unlimited number of 60 day periods). The patient signs an elective statement indicating he or she understands the nature of the illness and of hospice care. In addition to hospice services, the patient may continue to receive Medicare benefits not related to the terminal illness. In Colorado, Medicaid provides a similar benefit to Medicaid-eligible recipients.
In the Medicare and Medicaid systems, hospices are treated distinctly from other health care providers. During the time that a beneficiary is receiving hospice care, the reimbursement is based on a daily rate paid to the hospice program for each day, without regard to the specific services provided on any given day. Patients and families are spared the all-too-familiar deluge of bills and payment notices, because the claims-filing and reimbursements occur directly between the hospice and the payment source.
Many hospices offer care on a private pay, sliding-fee scale, or charitable basis for those who have insufficient insurance. Charitable care is provided through the generosity of grants, gifts, and donations to not-for-profit hospice organizations. For-profit hospices may have foundations to assist patients in need. Speak to your local hospice about these options.
Consumers: What is the Cost of Hospice Care, and Who Pays For It?. (2006). Retrieved May 9, 2006 from the Colorado Hospice Organization Website: www.coloradohospice.org
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