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Hospice and Palliative Care Costs: What You Need To Know

planning hospice palliative care costs

When most people picture their future, they picture relaxing days hanging out with the grandkids, or weeks of long vacations that involve an RV, and roadmap and a sense of adventure. What they do not picture, and therefore do not plan for, is illness and disease, hospice care and palliative care. Unfortunately, life is full of surprises, some of which are not good. Cancer and other terminal illnesses can happen, and while most people don’t want to plan for them, they should, as long-term care can be costly. If you want to ensure that you get the care you need when you need it, keep reading to learn more about comfort care, who pays for it and what you can do to safeguard your future.

Understanding Comfort Care

Palliative and hospice care, sometimes referred to as “comfort care,” is an essential part of medical care at the end of life. Both palliative and hospice care in Arizona are meant to provide comfort to sick and terminally ill patients, but there are differences. Palliative care begins at the time of diagnosis, and it involves ensuring that a patient is comfortable and well cared for throughout the course of treatment. Hospice begins after the treatment of a disease has stopped and when it has become clear that a person is terminal. This type of care usually begins after a doctor has given a patient six months or less to live. For a detailed comparison see Palliative Service vs Hospice Service.

Private Insurance Coverage

doctor with patientMost private and public health insurance plans offer hospice and palliative care coverage. However, in order to reap the benefits of said coverage, you need to plan ahead. If you want to ensure that you or a loved one is covered under private insurance, you need to talk to your insurance provider about adding this type of coverage to your policy. This may involve disclosing information about your own health history as well as your family’s. By adding comfort care to your private insurance plan, you will automatically see a boost in your insurance premium. How much of a boost, however, depends on your risk. If you want to add comfort care simply for peace of mind, the premium difference may not be that much. However, if you want to add comfort care because of a family history of terminal illness, the bump in premiums could be significant.

Medicare, Part A and Part B

Private insurance companies are not the only ones that cover comfort care. If you have Medicare Part A and meet the following conditions, you may be eligible for coverage:

  • Your regular doctor and hospice doctor have certified that you are terminally sick and have six months or less to live;
  • You accept palliative care instead of care to cure your illness; and
  • You signed a statement certifying that you opted for comfort care in lieu of other Medicare-covered treatment for your disease and symptoms.

If you qualify for coverage under Medicare Part A, you will be eligible to receive doctor services, nursing care, hospice aid and homemaker services, therapy, necessary medical supplies and equipment, dietary counseling, grief and loss counseling for both you and your family members, short-term inpatient care for pain and symptom management, prescription drugs and any other services necessary to provide you with utmost comfort at such a difficult stage in your life.

If you do not qualify for Medicare Part A hospice coverage, you may still qualify for Medicare Part B coverage. Medicare Part B doesn’t cover the entirety of comfort care, but it could help to lessen the financial burden for both you and your family. Though it doesn’t cover as many services as Part A does, Part B may cover some treatments, prescription medications, doctor and nurse visits and social worker visits. You may be required to pay a small fee or co-pay, so be sure to inquire about this and set up a fee schedule before care begins.

Medicaid 

If you did not have the foresight to add comfort care to your private insurance policy, and if you do not qualify for Medicare Part A or Part B, your comfort care may be covered by Medicaid. Medicaid is generally for individuals who have low income and little to no assets. If you hope to qualify for Medicaid coverage, you may need to provide proof of income, or lack thereof, to receive doctor and nurse visits, treatment and medications.

What Comfort Care Coverage Doesn’t Cover

nurse with patientNo matter which entity covers your care—Medicare, Medicaid or a private insurer—there are a few items that comfort care coverage will not cover. These include treatments intended to cure your illness, prescription medications used for anything but pain management, room and board, care provided by anyone but the doctor and/or nurse assigned to you by your hospice team, and any care provided at an inpatient or outpatient facility that was not set up by your hospice team.

It Helps To Plan Ahead

The best thing you can do for your future and the future of your loved ones is to plan ahead. Nobody plans to become terminally ill, but unfortunately, it does happen. If you want to ensure that you receive the care you need in the event of a terminal diagnosis, and if you want to make sure that you and your family receive the grief counseling you need to make it through such a difficult time in your lives, talk to your insurance provider about adding hospice and palliative care to your policy. Hopefully you will never need it, but if you do, you can have peace of mind in the last few months of your life.

February 28, 2018

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