What is the Cost of Hospice Care?

The cost of hospice care and how to pay for it is a critical consideration in end-of-life planning. About 85% of end-of-life care costs are covered by government entities, primarily Medicare. Hospice care, funded by Medicare since 1982, plays a significant role in end-of-life support.

Medicare Coverage for Hospice:

• Medicare covers 85.4% of end-of-life care costs (listed out in detail at the end of this post*)
• Hospice care is available for Medicare beneficiaries aged 65 and older with a serious illness.
• Eligibility requires certification from a doctor predicting a life expectancy of six months or less.
• Hospice services include routine home care, continuous home care during crises, inpatient care, and respite care for caregivers.
• Medicare covers a range of services, such as nursing care, counseling, and bereavement services.
• Costs not covered include room and board, emergency care, and treatment attempting to cure illness.
• More information and coverage can be found on Meidcare.gov

Medicaid Coverage:

• Medicaid covers end-of-life care for those meeting financial eligibility criteria.
• Dual-eligible Medicare beneficiaries may have Medicaid cover costs not included in Medicare, like outpatient drugs and long-term care.
• Medicaid covers at least 95% of room and board costs for hospice patients in nursing homes.

Private Insurance:

• Private health insurance plans vary in coverage for hospice care.
• Policies with hospice coverage generally cover most costs, but some may have limits.

Other Options:

• TRICARE and CHAMPVA, government-sponsored health care programs, cover hospice care for military personnel and eligible beneficiaries.
• Individuals without insurance or government coverage may need to pay for end-of-life care themselves or explore sliding scale options and charitable support.

Costs of End-of-Life Care:

• A 2022 study showed hospice care for terminal patients with non-sudden illnesses cost 3.1% less than non-hospice care.
• The average end-of-life care cost is $67,192, decreasing with longer hospice stays.
• Hospice care is found to improve the quality of end-of-life care, reduce healthcare costs, and provide a good return on investment for taxpayers.
• Patients entering hospice earlier in their illness save an average of $14,000 in the last three months of life compared to mid-term stays.
  

*Services Covered under the Medicare Hospice Benefit:

The way hospice services operate in the United States is mostly determined by the Tax Equity and Fiscal Responsibility Act of 1982. As per this law, the services covered under the Medicare Hospice Benefit include:

1. Physician Involvement: Your regular healthcare provider will usually work together with the hospice medical director to oversee your care.
2. Nursing Services: A case-manager nurse is typically assigned to hospice patients, visiting one to three days a week. Additionally, an on-call nurse is available 24 hours a day when needed.
3. Lab Tests: Essential diagnostic studies, such as blood tests and X-rays, are provided as part of hospice services, in line with standard medical practices.
4. Medical Equipment: Hospice ensures a safe and comfortable environment by providing necessary equipment like hospital beds, wheelchairs, adult diapers, bandages, and disposable latex gloves.
5. Medication Coverage: All medications related to the patient's diagnosis, as well as those for pain and symptom control, are generally covered by hospice.
6. Therapy Options: Hospice can offer physical, occupational, or speech-language therapy as needed for patient care.
7. Social Services: Certified social workers are assigned to hospice patients to help with practical and emotional needs for both the patients and their families.
8. At-Home Assistance: A hospice home health aide can assist with personal care (like bathing or dressing) and help caregivers with chores. Services are typically provided two to three times a week based on need.
9. Counseling Services: Hospice patients and their families have access to dietary counseling, pastoral or spiritual support, and grief counseling upon request. Hospices are also required to offer bereavement counseling to family members and caregivers for at least one year following the patient's death.
10. Respite Care: This is a temporary, short-term assistance program aimed at helping caregivers avoid stress and burnout.

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