When it’s time to make the decision about whether hospice is right for you or your loved one, the last thing you want to worry about is money. Even if you have insurance, the process can be confusing and frustrating. Hassan Salhi, a billing coordinator at Crossroads, breaks down the different ways hospice care is covered.
Who Is Eligible for Hospice Care?
Hospice eligibility is a clinical diagnosis, made by your primary doctor. It is determined by assessing whether or not the patient’s medical condition is terminal. A terminal diagnosis is established when the patient is not expected to live more than six months if the illness runs its standard course. This diagnosis must be made in order for an insurance company to consider covering hospice care.
Who Pays for Hospice?
Hospice is generally covered by some form of insurance. Insurance can be complicated to understand, even when you’re not dealing with the stress of illness. Here are the basics:
- Medicare covers people over the age of 65 and those with certain disabilities. If you or your loved one is covered by Medicare, the government will pay 100 percent of your hospice fees—including medical supplies and prescriptions relating to pain and comfort management. Under Medicare, there are no deductibles and no copays.
- Medicaid covers many low-income patients, but it isn’t limited to those we traditionally think of as financially struggling. For example, some younger hospice patients are covered by Medicaid, because they are older than 18 years old, but do not have a job with extensive insurance benefits. Our billing coordinators are able to discuss Medicaid options on a case-by-case basis.
- Private/Employer Insurance is the most complicated form of payment that comes through the billing department. Most insurance companies offer a hospice benefit, but it can be confusing for families and patients to understand how much is covered because each plan is different. Just as coverage for emergency and dental care can vary, hospice coverage differs depending on the type of insurance plan you have. Studying your particular benefits package is key to comprehending how much you’ll be paying for hospice.
If Medicare Is Paying for Hospice, Why Did I Still Get a Bill?
One thing that often causes confusion for patients and their families is the difference between hospice-related care and non-hospice-related care. Medicare, Medicaid and most insurance plans will cover the cost of hospice—which includes things like medical supplies and pain medicine. This is hospice-related care.
What they won’t cover is non-hospice-related care, which is defined as any care needed that is not related to comfort of the patient. (Confused? Think of it this way: If the patient needs stitches after an accidental fall or catches a cold and needs a Z-pack, those expenses aren’t related to hospice and would not be covered.)
What If I Don’t Have Insurance?
No patient is ever denied hospice care because of inability to pay. Please give us a call at 888-603-MORE, to discuss your situation. We will work to find the best solution for your family.
How Do I Learn More?
Crossroads Hospice is here for you 24/7. You can call our billing department at any time to get information for yourself or a loved one.