In this episode, Mitch tackles one of the most common questions asked, how much does hospice cost and how do we pay for it?? The episode ends with a short great story!
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welcome to another episode of Living With Hospice. My name is Mitch Ware and I'm your host. I've been involved with hospice for quite a few years, both as a trained hospice volunteer and a family caregiver. You know is I've mentioned in previous episodes. I'm, ah, hospice volunteer. I'm not a doctor. I'm not a nurse. I'm not a social worker or a therapist. I'm not a hospice administrator, but I do have a lot of firsthand experience with several hospice organizations, both as a client and as a volunteer, and I want to share some of my insights with you. One of the most common questions ask is, how much does hospice cost? I mean, how do I pay for it? Especially if I don't have any money or if I don't have insurance? Well, let's start with how much hospice care costs. The answer depends on the particular hospice organization, and whether or not your loved one is using home care or inpatient care. There, several things that, um, go into the cost of hospice service is that being said, your out of pocket costs are determined, really, by several factors, like if you have private insurance or if you qualify for Medicaid or if you have V A benefits. And, of course, if if you choose to do private pay when we start to talk about medical care, one of the first things people ask is, Well, it must cost a lot, and how will I ever afford it? The good news is hospice care is probably covered by your insurance program as well. A cz Medicare. Some portions, like inpatient care, may be covered by Medicaid if you qualify for Medicaid. The Veteran's Health Administration also covers hospice care. If a patient does not have coverage, many but not all, but many hospice organizations will work with the patient and their families to ensure that they receive the support they need. Some hospice organizations give qualifying patients up to well 100% in a in a grant or scholarship to cover all of their hospice care expenses. One nonprofit hospice organization here in our community covered over $1 million of hospice care grants and scholarships. Now I found this interesting Americans hospice costs for 2016 which is the latest data I could find were paid for in the following manners. Medicare paid for 85 little over 85%. Medicaid picked up 5% managed care or private insurance about 7%. And charities or self pay picked up almost 3%. Nearly 90% of Americans end of life care costs are covered by various government entities, including, well, like we mentioned Medicare and Medicaid and health care program sponsored by well organizations like the Veterans Administration and Private Medical and Long Term Care Insurance. Medicare, by the way, is required to pay for all medically necessary hospital and DR Care under Parts A and B, regardless of cost or condition to the patient. Now that's assuming that you qualify for Medicare. Of the 2.7 million Americans who died in 2015 did you know 82% were Medicare beneficiaries at the time of their death? Yeah, Medicare Hospice Benefit has paid for the care of eligible patients since 1982 so I often ask, what? How does somebody qualify for hospice care benefits if there are Medicare? Here's some of the basics. The patient must be 65 years or older. They must be diagnosed with a serious illness, resulting in a terminal condition certification from a doctor that he or she has six months or less to live, agrees to forgo curative care or life saving or potentially curative treatment. And finally, the hospice provider must be Medicare approved. So how much coverage does Medicare cover? Well, Medicare provides care for to 90 day periods in hospice, then an unlimited number of 60 day periods. At the start of each period of care, a doctor must recertify that the patient has six months or less to live. Now, I can tell you, I've had patients that we're on hospice care for over a year. Why is that? Well, each individual case is unique, but I think the common threat is that patients in hospice care received terrific care. They get their meds on time. They're constantly being monitored and they're made comfortable. And in those conditions, patients tend to thrive. Now let's look at hospice costs that are not covered by Medicare. An example of that would be room and board for inpatient care emergency care such as an ambulance fee or emergency room costs. Again, those may be covered by Medicaid or even a private pay or a charitable donation. Medicaid is an interesting dynamic here. Adults who meet Medicaid's financial eligibility criteria are fully covered for end of life care. Medicare beneficiaries who are dual eligible for both programs, which is probably 20% of all Medicare beneficiaries, can have Medicaid covered costs that Medicare doesn't cover, such as an outpatient prescription and impatient long term care. Check this out. Thes expenses vary from state to state and from provider to provider, so you need to do your homework. You need to check it out a little bit. You may have to put on your negotiating hat, depending on what state you live in. I've done some negotiating with Medicaid here in Michigan. It's not fun. But if you stand your ground and state your case politely and professionally, you can often, uh, win your case. Oh, and for the record, Medicaid in Medicare's hospice eligibility requirements are pretty much identical. A patient must be certified to have six months or less prognosis and the patient. Most received service is from a Medicare certified hospice facility or agency. However, Medicaid policies concern can vary from state to state. So again, you need to check with your state Medicaid Department of State government. Let me reiterate this point. In addition to covering hospice service is Medicaid also pays at least 95% of room and board costs for hospice patients in a nursing home or assisted living facility. Funds are allocated to the hospice agency, which then pays the nursing facility. So let's take a minute and discuss private insurance in private. Pay for hospice service is and how that works. Private health insurance plans vary in terms of coverage. If the policy includes hospice, end of life care or palliative care, it will cover most of these costs. Not all plans pay for hospice care, although the vast majority due since it's typically much less expensive than hospital treatment and curative care. Some policies that cover hospice care may have limits on hospice expenses, so if you have private coverage, you need to read your coverage summary. Read the fine print and call your provider to get total information. As for private pay, your hospice care provider will give you an expense schedule based on either in home care or inpatient care. They're wonderful explaining your options and helping you navigate thes, sometimes treacherous waters. You know I've noticed that there are many communities that have Medicare and Medicaid conferences. They're typically held in a hotel banquet room or a conference room someplace, and they're open for the public. Now you need to realize going in that someone is probably going to try and sell you something. They're gonna try and tell you probably supplemental insurance plans, and that's why they really have invited you. I recommend two ways of getting informed on hospice related Medicare and Medicaid coverage questions. First go online. Go to www dot Medicare dot gov forward slash coverage forward slash hospice care. And if you can't remember all that, go to www dot Medicare dot gov forward slash coverage and then you can scroll down to hospice care. There, you can get information from the official U. S government website for Medicare that will explain exactly what Medicare covers and you can get information about Medicaid from your state government website or, if you'd rather every hospice has a person and some have several people. Actually, that can help you navigate how to work with your private insurance, your private pay or Medicare and Medicaid. As previously mentioned, private insurance is very straightforward and easy to work with. You file a claim and your insurance provider than pretty much takes it from there. Medicare and Medicaid can be tricky, so utilize the staff at hospice to help you navigate those waters. So how much does hospice cost? Well, it depends on whether you use in home or inpatient care. How much out of pocket expenses there with hospice care again depends on your situation. Do you have private insurance or do you use Medicare? And if you do, do you also use Medicaid? Depends on if you qualify for those or are you going to use Ah, private pay method? Most people have little to no out of pocket expense that use insurance, Medicare or Medicaid. Can I be turned down? If I can't pay well, nonprofit hospice organizations will not turn you away because you can't pay. And if you do not have any coverage by Medicare and Medicaid or a private insurance program a nonprofit hospice can provide, service is to you free of charge as part of its charitable mission. The nonprofit status of the hospice often requires it to provide charitable service is such as this for profit. Hospices often have a foundation set aside to help with those folks that need assistance, so that's a great place for us to start. Next episode will look at what is the difference between a nonprofit, any for profit hospice organization. In the meantime, if you have any questions about hospice or a hospice situation, please drop us a note at livingwithhospice@gmail.com. We may uncover your question in a future episode. Thanks for spending some time with us today on this podcast and until next time I'm itch. Where for Living with hospice. Have a blessed rest of your day.