Who Pays For Inpatient Hospice Care?

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

When faced with the overwhelming journey of end-of-life care, families often find solace in inpatient hospice facilities. These sanctuaries provide medical, emotional, and spiritual assistance to patients and their loved ones. Yet, a pressing question often arises, “Who pays for inpatient hospice care?” Delve into this crucial topic with us as we break down the various avenues of financial support available, ensuring that the last days of a dear one are as comfortable and dignified as possible.

Medicare Hospice Benefit

The Basics:

Medicare is the federal health insurance program for seniors 65 and over. One of its components, the Medicare Hospice Benefit, covers a significant portion of inpatient hospice care costs.

Example:

Take Martha, for instance, a 67-year-old diagnosed with terminal cancer. Martha qualifies for the Medicare Hospice Benefit, meaning most of her inpatient hospice expenses are taken care of, lifting a financial burden off her family’s shoulders.

Medicaid Hospice Coverage

The Basics:

Medicaid, a state and federal program, assists low-income individuals and families. Many states have a hospice benefit within their Medicaid programs to cover inpatient hospice care costs.

Example:

Consider James, a 58-year-old with a terminal illness who does not have substantial savings. James qualifies for Medicaid in his state, and as a result, his inpatient hospice care expenses are mostly covered, easing his family’s worries during an already challenging time.

Private Health Insurance

The Basics:

Many private health insurance plans have provisions for hospice care. While the specifics might vary, most plans provide a hospice benefit that can alleviate a significant portion of the costs.

Example:

Let’s think about Rebecca, a 50-year-old terminal patient. Her corporate health insurance plan covers 80% of her inpatient hospice care costs, giving her peace of mind during her final days.

Long-term Care Insurance

The Basics:

Long-term care insurance, often purchased separately from regular health insurance, primarily covers services not covered by regular health insurance, Medicare, or Medicaid. Some of these policies include provisions for hospice care.

Example:

Robert, aged 72, had the foresight to purchase long-term care insurance a decade ago. Now, diagnosed with a terminal illness, Robert discovers that his policy covers the bulk of his inpatient hospice care costs, a testament to his forward thinking.

Charitable and Nonprofit Organizations

The Basics:

Certain charitable organizations provide financial support for those needing inpatient hospice care but lack the means to pay for it. While they might not cover all the costs, they can considerably lessen the financial strain.

Example:

Anna, 63, has no insurance and limited savings. She finds solace in a local charitable organization that offers to pay for a portion of her inpatient hospice care, ensuring she receives the care she deserves.

Out-of-Pocket

The Basics:

Sometimes, families choose or need to pay for inpatient hospice care out of pocket. This could be due to a lack of insurance, specific desires related to care, or other reasons. Many hospice facilities offer sliding-scale fees based on a family’s ability to pay.

Example:

Mike, 55, wants a specific hospice facility that isn’t covered by his insurance. His family decides to pay for it out-of-pocket, ensuring Mike’s last days are spent precisely where he wants to be.

Next Steps

The journey of inpatient hospice care is emotionally taxing, and concerns about finances should be the last thing on anyone’s mind. Understanding the various payment options available—Medicare, Medicaid, private insurance, long-term care insurance, charity, or out-of-pocket payments—can provide clarity and peace during challenging times. Ensure you explore all available avenues, ask plenty of questions, and find the best solution tailored to your unique circumstances.

Who Pays For Inpatient Hospice Care

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Frequently Asked Questions

What are the fast 7 criteria for hospice?

The “FAST” (Functional Assessment Staging Test) scale is commonly used to assess the progression of Alzheimer’s disease and may be used as part of the criteria for hospice eligibility. A FAST score of 7 indicates severe dementia, often characterized by an inability to speak or walk. Meeting this or similar criteria may make an individual eligible for hospice care under Medicare, Medicaid, or private insurance, depending on the policy’s terms.

What happens if you live longer than 6 months in hospice?

You can still receive hospice services if you live longer than the initial 6-month hospice care period. Eligibility is re-evaluated at regular intervals, and if you continue to meet the criteria, services can be extended for additional 60- or 90-day periods as needed.

Who is eligible for hospice care?

Eligibility for hospice care generally requires a terminal diagnosis with a life expectancy of 6 months or less, as certified by a physician. The focus shifts from curative treatment to comfort and palliative care.

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

Shawn Plummer is a Chartered Retirement Planning Counselor, insurance agent, and annuity broker with over 14 years of first-hand experience with annuities and insurance. Since beginning his journey in 2009, he has been pivotal in selling and educating about annuities and insurance products. Still, he has also played an instrumental role in training financial advisors for a prestigious Fortune Global 500 insurance company, Allianz. His insights and expertise have made him a sought-after voice in the industry, leading to features in renowned publications such as Time Magazine, Bloomberg, Entrepreneur, Yahoo! Finance, MSN, SmartAsset, The Simple Dollar, U.S. News and World Report, Women’s Health Magazine, and many more. Shawn’s driving ambition? To simplify retirement planning, he ensures his clients understand their choices and secure the best insurance coverage at unbeatable rates.

The Annuity Expert is an independent online insurance agency servicing consumers across the United States. The goal is to help you take the guesswork out of retirement planning and find the best insurance coverage at the cheapest rates

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