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99% of Hospice Patients Don't Have To Pay

Shouldn’t you know more about the Medicare hospice benefit?        

Like most things in life, there is an expense associated with healthcare. How many times have we seen individuals neglect health issues because they could not afford to see a doctor?

VITAS® Healthcare, the nation’s leading provider of end-of-life care, is here to share some good news in the cost-intensive healthcare universe:Virtually anyone who needs end-of-life care can get it at no cost, thanks to the Medicare hospice benefit. That is welcome information for someone who is seriously ill and considering hospice, but worried that hospice care could potentially saddle family members with bills.

In fact, less than 1 percent of hospice patients (0.8 percent) have to pay for their care, and most of the credit for that goes to the Medicare hospice benefit. Roughly 84 percent of hospice patients are covered by Medicare, making it the most popular payment mechanism for hospice services.

The Medicare hospice benefit

Medicare is a federal health insurance program for U.S. citizens and permanent residents who are at least 65 years old. It is available to people younger than 65 with certain qualifying disabilities.

The Medicare hospice benefit, which began in 1982, covers 100 percent of patient costs related to a terminal illness for the final six months of life. Yet more than half of all Medicare beneficiaries do not take advantage of the Medicare hospice benefit. Those who do tend to be admitted in the last week of life.

More than 1.38 million Medicare beneficiaries received at least one day of hospice services in 2015. The median length of hospice service for those patients was 23 days, with close to 30% enrolled for seven days or fewer.

Hospice care is comfort care, or “palliative” as opposed to “curative.”The Medicare hospice benefit does not cover treatments that are intended to cure a terminal illness or related conditions.

If a hospice patient has health problems unrelated to the terminal illness, regular Medicare, as opposed to the hospice benefit, pays for doctor services, prescription drugs, nursing care, medical equipment and short-term inpatient care related to the non-hospice-related health problems. The beneficiary may pay a deductible or co-insurance costs.

Four levels of hospice care

Medicare mandates four levels of hospice care that every Medicare-certified hospice must offer. A patient may receive one or all four levels of care at different times, depending on their needs.

  1. Routine home care: The hospice team, patient and family establish a plan of care that the team carries out during visits to the patient’s home, with the family caregiver providing care at all other times.
  2. Continuous (24-hour) care: If symptoms become difficult to manage, the hospice must provide shifts of care in the home for up to 24 hours/day until the symptoms are under control and the patient can return to routine home care.
  3. Inpatient care: If symptoms cannot be managed at home, the hospice must provide care in a facility that offers round-the-clock medical care until the patient is stable and can return to routine home care.
  4. Respite care: Inpatient care for any hospice patient when the caregiver needs up to five consecutive days of relief from care, after which the patient and family return to the previous level of care.

Who is hospice-eligible?

To qualify for the Medicare hospice benefit, a Medicare beneficiary needs to be:

  • - Diagnosed with a terminal illness 
  • - Certified, in the best medical judgment of their physician and a hospice medical director, to have six months or less to live
  • - Willing to stop preventive treatments in preference to palliative care

Medicare’s hospice benefit is comprised of two 90-day benefit periods and an unlimited number of 60-day benefit periods, each certified by a hospice physician after a physical evaluation.

A hospice patient can leave (revoke) hospice care at any time and can be readmitted at any time, as long as they qualify. Should a beneficiary revoke or be discharged from hospice care, the remaining days in the benefit period are lost.

Medicaid and hospice

In most states, Medicaid covers all the costs of hospice care for residents who qualify for Medicaid and meet the hospice requirements. Roughly 5 percent of all hospice patients are covered by Medicaid.

As of 2010, when the Affordable Care Act was enacted, Medicaid-eligible individuals under age 21 who qualify for the hospice benefit no longer need to waive services for the cure or treatment of their terminal illness and can simultaneously get curative care and hospice care.

Most of Medicaid’s hospice benefits mirror those of Medicare, although there may be a bit of variation in some states. For more information about hospice for Medicare and Medicaid beneficiaries, click here.

Along with the Medicare hospice benefit, a number of federal, state and private-coverage funding options exist for hospice care.

To find out more about the expenses associated with hospice care, click here.

What does hospice look like?

VITAS’ nearly 12,000 professionals care for more than 17,000 terminally ill patients on an average day, primarily in the patients’ homes, but also in the company’s 27 inpatient hospice units as well as in hospitals, nursing homes and assisted living communities or residential care facilities for the elderly.

Hospice controls symptoms and keeps patients comfortable without frequent visits to emergency rooms, ambulances and ICUs. Statistics show that most of us hope to end our lives peacefully, at home with family members, not in a hospital. VITAS can help bring comfort to the end of life.

There are many kinds of hospice providers: large, small, church-based, hospital-based, for profit, nonprofit, etc. Because all hospice organizations are reimbursed the same way, hospices do not compete on cost. Quality of service and the spectrum of choices is what differentiates hospices.

VITAS offers services that range from home visits by a registered nurse or aide to music therapy, pet visits and outings of the patient’s choosing. There is even an after-death benefit that offers bereavement support to those affected by the death

For more information about hospice care or your end-of-life care options, call VITAS Healthcare at 866.759.6695 or visit