Medicaid and Medicare Hospice Coverage
Individuals needing hospice services often turn to Medicare or Medicaid seeking coverage for hospice care. If you or your loved one needs hospice care, you likely want to know whether Medicare or Medicaid provides hospice coverage.
Learn whether Medicare covers hospice-related care and whether Medicaid provides coverage for hospice services.
Does Medicare Cover Hospice?
Medicare covers hospice for eligible Medicare recipients. There are several guidelines and regulations that you have to meet for Medicare to pay for hospice-related care and services.
Medicare explains that hospice care is for those individuals with a life expectancy of six months or less if the medical condition or disease continues to progress or run its normal course. Medicare further states that your hospice doctor or your regular physician certifies you as terminally ill with a life expectancy of six months or less.
You are potentially eligible for Medicare-covered hospice care if you have Medicare Part A benefits and sign a statement indicating you want hospice instead of other Medicare-covered treatments. You willingly accept palliative care instead of curative care for your condition.
There is no deductible for hospice care. You still pay your Part A and Part B premiums.
What Is The Medicare Hospice Benefit?
Hospice care covered by Medicare includes physician services, nursing care, hospice aide and homemaker services, prescription medications for symptom relief or pain relief, medical equipment and medical supplies.
Medicare coverage also includes physical therapy, occupational therapy, speech therapy, dietary counseling, social worker services, grief, and loss counseling for yourself and family members. You have the benefit of a hospice doctor and nurse on-call, twenty-four hours a day, seven days a week.
Hospice care covered by your Original Medicare benefits is often provided in your own home. Some people receive care in a hospice inpatient facility.
Check with your plan provider if you have a Medicare Advantage or Medicare Supplement plan.
There are exceptions to hospice coverage provided by Original Medicare. Medicare does not pay for room or board at your home or if you live at a skilled nursing facility or in a nursing home. Medicare covers short-term respite or hospice facility care arranged by your hospice team. You may be responsible for paying a small co-payment of five percent for your respite stay.
When you make the decision to receive hospice care, you are making the decision not to continue efforts to cure your terminal illness. Your doctor may also decide that efforts to cure your condition are not effective any longer.
Medicare covers hospice care in benefit periods. You initially have two 90 day benefit periods. After you use those, there are unlimited 60-day periods that you receive hospice care benefits.
You receive coverage for everything normally covered by Medicare outside your terminal illness. The Centers for Medicare & Medicaid Services (CMS) explains that when you receive treatment for something other than your terminal illness, your co-payments and deductibles still apply for other Medicare services.
Does Medicaid Cover Hospice?
Medicaid allows state options for hospice care. There are a few state Medicaid programs that do not cover hospice. Until 2013, only Connecticut, Oklahoma and New Hampshire Medicaid programs did not cover hospice. In 2013, Louisiana stopped covering hospice for Medicaid recipients, stating that hospice services are often covered by other benefits provided by Medicaid. A statement indicated they would save more than $8 million dollars annually by discontinuing Medicaid hospice coverage.
While most states define a terminally ill individual as a person with six months or less to live, New York uses 12 months as its guideline.
Medicaid coverage for hospice care requires that you complete an election statement with a specific hospice agency or facility. That hospice facility acknowledges that efforts and medications to cure your terminal illness are waved. Your hospice team provides your Medicaid-covered hospice care.
The Affordable Care Act brought a change to this regulation for hospice care for individuals under age 21. Medicaid indicates that those under 21 do not have to waive care or treatment services that potentially cure the terminal illness. These individuals receive both curative and hospice care.
What Is The Medicaid Hospice Benefit?
One Medicaid benefit in the states that provide coverage is that individuals have the opportunity to receive hospice care even if they do not have Medicare coverage.
Medicaid covers care and services from doctors and nurses, home health aide and homemaker services, medical equipment and supplies, short-term inpatient care as well as speech-language services, occupational therapy and physical therapy.
Other coverage includes palliative care, medical social services and counseling for you and your family members or other individuals caring for you in your home.
Where Can I Find Medicare And Medicaid Hospice Near Me?
Every hospice facility does not have to accept coverage from Medicaid or Medicare.
When you receive notice of eligibility for Medicare or Medicaid hospice coverage, work with your hospice team to obtain hospice care and services you need in your own community.
Ask for help from your hospice social worker or counselor.
Check with a senior care agency for hospice options if you have Medicare coverage or are dually eligible for both Medicare and Medicaid.