Medicare, Medi-Cal, and Private Insurance
Hospice care is a fully covered benefit under Medicare Part A and the Medi-Cal program in California. Most private insurance companies also provide coverage for hospice care but are subject to individual policy deductibles, coinsurance, and out-of-pocket limitations.
When you are considering hospice care, your insurance coverage will be reviewed and discussed to be sure you understand the financial benefits Any questions will be resolved prior to the start of care.
If you are eligible for and enrolled in Medicare or Medi-Cal, there is no out-of-pocket cost for hospice. The hospice benefit includes full payment for all staff services, supplies, medical equipment, and medications, provided they are directly related to the hospice primary diagnosis.
To qualify for hospice care, two physicians (generally your attending physician and the hospice physician) evaluate you to determine if you have a life-limiting illness with a life expectancy of six months or less. Because it is impossible to know the progression of a disease with accuracy, you may receive the hospice benefit for longer than six months provided you continue to meet the Medicare or insurance company eligibility criteria. After six months, you will be assessed periodically by hospice physicians or hospice nurse practioner for continued coverage.
When you elect the hospice benefit for a specific disease diagnosis, you opt out of traditional Medicare coverage and opt into the special Medicare hospice benefit. By doing this, you agree to pursue comfort and palliative measures only and not to seek aggressive or curative therapy for that disease. Should other diseases develop, unrelated to the hospice diagnosis, those may be treated and covered under the traditional Medicare program.
When all requirements are met, the following services will be covered by your health plan:
- Physician services
- Nursing care
- Home health aide
- Medical social services
- Bereavement counseling
- Spiritual counseling
- Dietary counseling
- Volunteer services
- Physical therapy, occupational therapy, and speech therapy
- Medical equipment, services, and supplies
- Medications for pain and comfort related to the terminal illness and approved by Skirball Hospice
- Short-term inpatient care for pain and symptom control
- Diagnostic studies
- Short-term crisis care for focused symptom relief
- Respite care for up to five days to provide relief for caregivers
The following services are not covered:
- Treatment for the terminal illness that is not for palliative symptom management and is not within the hospice plan of care
- Care provided by another hospice or home health agency
- Private caregivers/sitter services
- Dietary supplements, unless directly related to terminal illness
- Services not authorized by Skirball Hospice
- Ambulance transportation not included in the plan of care
- Supplies not related to terminal illness
- Chemotherapy drugs or other drugs deemed aggressive in nature
- Medications not related to the terminal illness
- Visit to the emergency department or inpatient hospitalization without prior authorization from Skirball Hospice
- Diagnostic studies or any treatments not authorized by Skirball Hospice
