Medicare coverage pays for many of the services offered by hospice. In order to be eligible, a patient must be covered under Medicare Part A and have a certification from a physician that the patient’s life expectancy is six months or less. This does not mean that the patient will lose their hospice benefits after six months. It simply means that in order to be eligible they must have a life expectancy of six months. As long as the individual continues to have a life expectancy of six months or less, hospice can go on indefinitely.
To enroll in hospice, the patient must sign a statement electing the hospice benefit. This is often a difficult step for families as it changes the course of treatment from curative (trying to help that patient get better) to palliative (treating the pain). Fortunately, the patient can change their mind and decide to go from hospice to non-hospice care if they choose.
One benefit of hospice care is that medication related to the terminal illness is covered with a minimal co-pay. Also, under Medicare law another hospice benefit is that patients can have a one-time educations consultation by a hospice physician, even if the patient is not yet enrolled in hospice. The consultation should include a pain assessment and counseling on care options and advanced planning.
If the patient is a nursing home resident, there will be hospice benefits available, similar to if the resident was at home. However, Medicare does not cover the costs of room and board at the nursing facility.
If the patient is not eligible for Medicare Part A, there are other ways for hospice care to be paid for. Health Maintenance organizations and managed care organizations often cover the cost of care. Many hospice programs will use a sliding fee scale, based on the patient’s ability to pay for services if benefit programs are not available.