Most hospice patients are eligible for Medicare, which comprehensively covers all aspects of hospice care and services. However, in certain instances, there might be a nominal co-payment for prescriptions and respite care. In the state of California, Medicaid offers similar coverage to eligible hospice patients.
It is crucial to emphasize that Original Medicare covers hospice even if the individual is enrolled in a Medicare Advantage Plan.
Important, if you have supplemental insurance, such as a Medicare Advance Plan or Medicare Part B, for which you are paying additional premiums, it is advisable to confirm with our professionals before cancelling any supplemental insurance policies.
While the original Medicare hospice benefit addresses costs related to the primary hospice diagnosis, ongoing treatment or medications for other health issues unrelated to the primary hospice diagnosis may not be covered by the hospice provider. In such cases, your supplemental policies may cover these additional expenses.
Certain Medicare Advantage plans may also cover the cost of some caregiving services in addition to those provided by Medicare-only coverage. Private health insurance plans, including those provided by employers, often offer a hospice benefit, but the extent of coverage for hospice care and services may vary between plans. For specific queries, please consult with our professionals to gain a better understanding of your insurance plan's coverage.
Hospice care can be provided for two 90-day periods, followed by an unlimited number of 60-day periods. While medical eligibility typically depends on the physician's opinion regarding a life expectancy of six months or less, neither the patient nor the physician faces penalties if the patient surpasses this timeframe. Recertification is possible for as long as the patient remains medically eligible.
In some instances, a patient's condition may stabilize or even improve to the extent that they no longer meet the medical eligibility criteria for hospice services. At this point, the patient is "discharged" from the hospice program, and their Medicare benefits revert to the coverage they had before opting for hospice care.
Occasionally, hospice patients may opt for curative therapies, such as participating in a clinical study for a new medication or procedure. To pursue this, the patient must withdraw their selection of hospice care, termed "revocation." Patients who are discharged or choose to leave hospice care can re-enroll without penalty whenever they meet the medical eligibility criteria.
For any inquiries regarding costs, coverage, out-of-pocket expenses, etc., please feel free to ask us. Our hospice professionals are here to help you understand the coverage provided by your insurance plan.
Military families can avail hospice coverage through Tricare.