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Does My Loved One Have Hospice Benefits?

Medicare, Medicaid, private insurance plans, HMOs, and other managed care organizations usually provide hospice benefits. Keep in mind that these benefits reflect these facts about hospice:

• Hospice focuses on caring, not curing. Your hospice team will provide expert medical care, pain management and emotional and spiritual support tailored to your needs.
• Hospice is a philosophy of care and can be delivered wherever the patient calls home. In most cases, care is provided in the patient's (or another person’s) home. It also is provided in freestanding hospice centers, hospitals, and other long-term care facilities.
• Hospice services are available to patients of any age, religion, race, or illness. You can continue to receive hospice for as long as your physician, after assessing your condition, determines that your illness continues to be life-limiting.
  

Medicare

There is a specific benefit for hospice called the Medicare Hospice Benefit. You can get the Medicare Hospice Benefit if:

• You are eligible for Medicare Part A (hospital insurance); and
• Your doctor and the hospice medical director certify that you have a life-limiting illness and have six months or less to live if your illness runs its normal course; and
• You sign a statement choosing hospice instead of curative treatment and standard Medicare-covered benefits for your life-limiting illness; and
• You enroll in a Medicare-approved hospice program. (More than 90 percent of hospices in the United States are Medicare certified.)

Other, non-terminal medical conditions you may have will be covered by your standard Medicare benefits.

Medicaid

There is a specific benefit for hospice called the Medicaid Hospice Benefit. If you have a low income and few assets, you may qualify for Medicaid,  a health insurance plan that helps people who cannot afford to pay some or all of their medical bills. Almost every state has a Medicaid Hospice Benefit. To find out if your state does, call the Caring Connections HelpLine at 800/658-8898.

Private insurance, HMOs, managed care programs

It is very likely that your private health insurance plan includes a hospice benefit. If you own a long-term care policy, it may include hospice benefits. To find out, talk with your health insurance or long-term care insurance representative. Also ask if there are any limits on the amount of hospice care benefits your insurance will pay for. If there are, talk with a hospice representative about financial resources you may be able to tap if your hospice benefit limits are exceeded. It’s a good idea to do this before enrolling in hospice. Keep in mind that you will never be asked to leave hospice simply because you cannot continue to pay for your care.