The data from the National Hospice Study (NHS) report in 1984 shows the average cost of hospice in the United States on a daily basis. The NHS report was mandated by the U.S. Congress to investigate the effects of the inclusion of hospice services in Medicare. The NHS data suggest that hospital-based hospice costs per day are 44% higher than home care hospice costs per day. Home care hospice cost per day was $66 per day compared to $95 per day for the hospital-based hospice.

The Centers for Medicare and Medicaid Services (CMS) has published an MLN Matters Article about the updated hospice payment rates for the Fiscal Year 2021. For the Fiscal Year 2021, routine home care from the 1st day up to the 60th day costs $199.25 per day. Routine home care beyond 60 days costs $157.49 per day. For continuous home care, the daily rate is $1,432.41 or $59.68 per hour. Inpatient respite care costs $461.09 per day, while general inpatient care costs $1045.66 per day. The CMS is a U.S. federal agency under the U.S. Department of Health and Human Services that provides health coverage to over 100 million American people through Medicare, Medicaid, and the Children’s Health Insurance Program.

 

Who Pays For Hospice Home Care?

Hospice home care is paid for by different government institutions. These government institutions include Medicare, Medicaid, private medical insurance, and healthcare programs sponsored by the Veterans Administration (VA) and the Department of Defense (DoD). Hospice care is paid by these entities in the following proportion: 85.4% of hospice costs are paid by Medicare, 5% of the hospice costs are covered by Medicaid, 6.9% of the hospice costs are paid by private insurance, and 2.7% of the hospice costs are from others like charity and self-pay.

Medicare has paid for hospice care for all eligible American patients since 1982. All hospital and hospice doctor or physician care under Parts A and B, regardless of cost or patient’s condition, are paid for by the Medicare beneficiaries. Medicare Part A consists of significant coverages, such as hospitalization, skilled nursing care, and some home health care. Medicare Part B includes more extensive coverage of services like outpatient services, doctor or nurse visits, lab tests, mental health, preventive care, some clinical trials, physical therapies and occupational therapies, and certain supplies and medically essential equipment, such as wheelchairs, walkers, monitors, commode chairs, hospital beds, and articulating mattresses.

Medicaid fully covers end-of-life care for American children with disabilities and American adults who meet Medicaid’s financial eligibility criteria. Medicaid’s financial eligibility criteria include groups from low-income families, qualified pregnant women and children, and people receiving Supplemental Security Income (SSI). Medicaid also covers those who are not under the scope of Medicare, such as outpatient prescription drugs and long-term care.

Most private insurance companies offer hospice coverage. The hospice coverage is up to a certain extent. The degree of hospice coverage and requirements differs from one insurance entity to another, so it is advisable for patients and their family members to check and verify with their insurance provider.

The Veterans Administration (VA) also offers hospice care as one of the benefits for American veterans. American veterans still need to meet the eligibility criteria and be enrolled in the VA healthcare system. Hospice care assistance benefits include the following like medical services and nursing services reimbursements, prescription reimbursements, supplies reimbursements, and equipment reimbursements that are given to American veterans. American veterans can also receive inpatient respite care from their primary caregivers to get temporary rest.

 

How Does Hospice Get Its Funding?

Hospices get their funding and payment from reimbursements made from Medicare, Medicaid, or private insurance. The reimbursements cover the number of days the patient is enrolled in the hospice care program, including the levels of hospice care provided by hospices. Hospices are paid on a flat daily fee basis, and some other hospice benefits like grief counseling may not be covered by Medicare, Medicaid, or private insurance. The extra fees from those services not covered are either shouldered by hospices or charged to the patients at the minimum amount.

Hospices also get their funding from contributions and donations. These contributions and donations are provided by individuals, corporations, bequests, foundation grants, association gifts, civic and fraternal groups, and program-related income. These donations allow hospice teams and hospice providers to improve their hospice care services, like providing free resources for patients and their families about end-of-life care, improving clinical practice using low-cost hospice education programs, and increasing grief and bereavement knowledge using national programming.

 

How To Pay For Hospice Care

Paying for hospice care is usually provided by Medicare and Medicaid. Medicare is a federal health insurance program that covers American people who are 65 years and older and also people with certain disabilities. Medicare is a program run by the state that offers coverage for patients that belong to low-income groups. Both Medicare and Medicaid have eligibility requirements for patients in order to get their hospice care covered.

Medicare does not cover the following services once the hospice benefit starts for patients. The first is any curative treatment to the hospice patient’s terminal illness or other related complications or problems will not be covered by Medicare. The second is that Medicare will not cover any care from any hospice provider that wasn’t chosen by the hospice team. The next is any prescription drug to cure the patient’s terminal illness will not be covered by Medicare. Lastly, Medicare does not cover room and board costs, such as in an assisted living facility, inpatient facility, hospice facility, or skilled nursing facility.

 

How Much Does Hospice Care Cost Out Of Pocket?

The Centers for Medicare and Medicaid Services (CMS) states that hospice care out of pocket costs or the coinsurance amounts for patients. The first is drugs and biological coinsurance. The drugs and biological coinsurance is from the drugs and biologicals used in order to address the pain management and symptom management of the hospice patient’s terminal illness and other related conditions. For every prescription of a hospice-related drug or biological, the patient needs to pay a coinsurance amount of 5% of the cost of the drug or biological to the hospice team or hospice provider. The maximum amount of coinsurance for each drug or biological prescription is $5. Patients under general inpatient care or respite care do not need to pay any drug and biological coinsurance.

The next coinsurance is respite care coinsurance. The respite care coinsurance is 5% of the Medicare payment for a respite care day. The coinsurance amount should not exceed the inpatient hospital deductible for the year the hospice coinsurance period began. Board and room costs are not included in the levels of care.

 

How Much Does Hospice Care Cost Without Insurance?

The cost of hospice care without insurance such as Medicare may amount to what Medicare is currently paying for hospice care. The daily cost of hospice care and palliative care service can be from $150 per day up to $500 per day. Without insurance coverage like Medicare, patients and their families will need to pay for hospice care services out of their pockets.

On the other hand, some hospice teams and hospice providers may provide hospice care for free or on a sliding scale basis. A sliding scale basis considers the patient’s income for the computation of hospice care costs. Patients with higher incomes will pay more, while patients with lower incomes will pay less for hospice care costs.

 

Contact Specialized Home Care to get more information on the Costs of hospice services that is right for you.