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Who Pays For Hospice Care?

Who Pays For Hospice Care?

Female Neighbor Helping Senior Woman To Complete FormLike many people, you likely have questions related to the cost of hospice care, and whether your private insurance or Medicare pays for this valuable end-of-life service. Read below to learn more about who pays for hospice.

Does Medicare Pay for Hospice?

Yes, Medicare Pays for Hospice Care

Most hospice patients in New Jersey have their hospice care covered through Medicare Part A, specifically the Medicare Hospice Benefit. This benefit pays for all hospice services related to the person’s terminal illness, except a small co-pay for prescriptions. The patient is responsible for this co-pay of up to $5 or 5% of each prescription — whichever is lower.

It’s important to note that the hospice benefit will not cover medications, medical equipment or services that are unrelated to the terminal diagnosis. For example, if a person has long-standing high blood pressure but is admitted to hospice due to terminal cancer, the hospice benefit will pay for the cancer drugs, but not the blood-pressure medications. The hospice staff can tell you which drugs are related to your terminal diagnosis, and which are not. In addition, costs of room and board are not part of the Medicare hospice benefit.

Samaritan Healthcare & Hospice is certified by Medicare to provide hospice care. We accept their reimbursement as coverage for services related to the primary hospice diagnosis. For care unrelated to the terminal diagnosis, Medicare A/B will continue to provide patients their routine benefits including physician visits.

Medicare Requirements for Hospice CareCaring, hispanic nurse and elderly senior patient in nursing home

In order to be eligible for hospice care under Medicare, the patient must be entitled to Part A of Medicare and be certified as being terminally ill  — having a prognosis of 6 months or less if the disease runs its normal course — by their attending physician and Samaritan’s medical director.

Does Medicaid Pay for Hospice Care?

Samaritan Healthcare & Hospice is also certified by Medicaid to provide hospice care. We accept their reimbursement as coverage for services related to the primary hospice diagnosis. For care unrelated to the terminal diagnosis, Medicaid will continue to provide patients their routine benefits including physician visits. Medicaid Hospice beneficiaries can also have the costs of their nursing-home room and board covered through the Medicaid Hospice Benefit.

Medicaid Requirements for Hospice Care

In order to be eligible for hospice care under Medicaid, the patient must be eligible for Medicaid, and be certified as being terminally ill  — having a prognosis of 6 months or less if the disease runs its normal course — by their attending physician and Samaritan’s medical director.

Additional Requirements for All Hospice Patients

Since hospice is a managed health care delivery system, any physician office visits, emergency room visits, hospitalizations, or treatments related to the hospice diagnosis must be coordinated through the Samaritan care team in order to ensure payment.

Does Private Insurance Pay for Hospice Care?

Most private insurance plans, military/VA plans, HMOs, and other managed care organizations also have hospice benefits that will pay for most, if not all, Samaritan services related to the hospice diagnosis.

Covered Hospice Services Can Include:

  • Visits by members of the hospice care team
  • Telephone access to on-call staff 24 hours a day, seven days a week
  • Medications related to the hospice diagnosis and any related conditions delivered by Samaritan’s pharmacy vendor
  • Medical equipment (e.g. hospital bed, oxygen, wheelchair, etc.) related to the hospice diagnosis and any related conditions delivered by Samaritan’s vendors
  • Supplies (e.g. adult briefs, catheters, wound dressings) delivered by Samaritan team members or vendors that make it easier for the family to care for the patient at home and improve comfort for the patient.

Check with your individual insurance carrier to find out the full extent of the potential cost of hospice care they will cover. Samaritan’s Social Work staff also can help families determine their covered benefits. They also assist families to resolve any financial hardships that may arise from gaps in coverage.

Close-up of hands of senior woman lying in hospital wardHospitalization

Sometimes, our hospice patients require a more acute level of care than is recommended in the home. The Samaritan Inpatient Hospice Centers in Mount Holly and Voorhees offers a soothing home-like setting for these services, when appropriate.

Patients requiring hospitalization must first call their hospice nurse. Families may be responsible for bills relating to unauthorized calls to 911 or visits to the hospital.

Medical Testing, Treatment and Procedures

The patient and family should review all anticipated treatments, procedures or testing with the hospice team nurse prior to having them done. If they are not related to the hospice diagnosis, the charges may be the responsibility of the family.

What is the Cost of Hospice Care?

The cost of hospice care will vary depending on a number of  factors, including whether you have private insurance, Medicare, or Medicaid. With that in mind, it’s difficult to give a general cost. We instead recommend that you contact us for a free, no-obligation consultation, and we can begin discussing care options and start to give you a general sense of the cost of hospice.

Call us to learn more: (800) 229-8183.