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​How is Hospice Paid For?

Hospice of the Western Reserve is a Medicare/Medicaid certified hospice program, offering a comprehensive hospice benefit. Most of our patients are Medicare/Medicaid eligible. You do NOT have to be over 62 to qualify for Medicaid. 


your-needs-quality.jpgHospice care services are paid for by Medicare, Medicaid, most commercial insurances and privately by the patient/family.

Once a diagnosis is given and a patient is determined eligible for hospice care, the hospice benefit can be elected. The hospice benefit pays for all medical care, medications and appropriate treatments that will provide comfort and alleviate symptoms and which are related to the diagnosis. Hospice cares for people wherever they live. Because of that, hospice care is provided in hospitals, nursing homes and assisted living communities as well as in private homes.

We know that health care payment can be complicated, the following is a guide to help you understand Medicare/Medicaid coverage. (If using commercial insurance, please check with the company.)

​Hospice care is covered by Medicare and Medicaid, Part A, B and C.

What part of hospice care does Medicare/Medicaid cover?

  • Physician services
  • Durable medical equipment (such as beds or walkers)
  • Medical supplies 
  • Medications for symptom control or pain relief
  • Nutritional/dietary counseling
  • Hospice aide
  • Social worker services
  • Short-term inpatient care (for pain and symptom management)
  • Short-term respite care (may need to pay a small copayment)
  • Extended or continuous care
  • Grief and loss counseling for the family

In most cases, supplies, equipment and even medications can be delivered to the patient's residence. Medicare supplements may help pay for particular aspects of care not fully covered by Medicare.


​​What you will be responsible for:

  • Your Medicare co-pay
  • Commercial Insurance co-pays and deductibles
  • ​​Nursing home room and board (if applicable)
  • Transportation costs between facilities
  • Prescription co-pays--(If on Medicare/Medicaid, your loved one will pay no more than $5 for each prescription drug and other similar products for pain relief and symptom control.)
  • Respite care room and board fees, if not a Medicare patient
  • 5% of the Medicare-approved amount for inpatient respite care--(For example, if Medicare pays $100 per day for inpatient respite care, your loved one will pay $5 per day. He or she can stay in a Medicare-approved hospital or nursing home up to 5 days each time he/she gets respite care.)
  • Treatments or medical supplies outside of the hospice plan of care 
  • Patients and/or patient families may be responsible for some costs associated with hospice care.
Contact the Financial Resource Advocate, contact 216.383.2222, ext. 2290.to make sure you understand what your responsibilities are with regard to payment.


Medicare and Medicaid Reimbursement Rates and Regulations

Unlike many medical treatments which vary in cost according to location or hospital system, the Medicare reimbursement for hospice care is fixed at a daily rate, regardless of the complexity of the care involved in assuring the patient's comfort. There are four hospice reimbursement rates and they are linked to what are called the "four levels of care": routine home care, general inpatient care, respite care, and continuous care. For additional information about Medicare and Medicaid and the hospice benefit, please visit Medicare/Medicaid or the Hospice Action Network.


Commercial Insurance and the Hospice Benefit

Most commercial insurers, such as those offered through an employer, also offer a hospice benefit. Because insurance plans vary, it is important to speak with your insurance provider (and supplemental insurance provider) as well as a Financial Resource Advocate at Hospice of the Western Reserve to fully understand your financial obligations.


Patient Self-pay and Financial Assistance

Some palliative care or hospice patients are self-pay. While this is unusual, it may happen that private insurance coverage is inadequate and they do not qualify for federal insurance programs. Rather than wait, the patient or family may choose to pay for some or all services directly. There are set fees for all services. Interest free payment plans can be arranged.


Our Care Promise

There may be special circumstances where Hospice of the Western Reserve patients and families need financial assistance. Circumstances such as:

  • You do not have medical insurance
  • Your medical insurance does not cover hospice or palliative care services
  • Your medical insurance has limited coverage
  • You completed a Medicaid application and are waiting for approval and/or you do not qualify

As part of Our Care Promise, a Financial Resource Advocate is available to conduct a financial assessment and help answer questions regarding your options. For an appointment call: 216.383.2222, ext. 2290. You and/or your family will be asked to provide documentation of financial need.


Help Us Help Others

In order to cover unreimbursed services and continue serving patients regardless of ability to pay, Hospice of the Western Reserve greatly relies on memorial gifts, private donations, community support and grants. We sincerely appreciate all gifts and pledge to use donated all funds in service to our patients and our communities. If you wish to help those who will receive care in the future, please visit our on-line donation page to make a gift.


Your Financial Health

We urge patients and families to consider the future by establishing a Power of Attorney (POA). Different and separate from a Health Care Power of Attorney, this individual (advocate) would be able to step in to make financial and legal decisions on behalf of the patient should he or she be unable to speak for themselves.

POA can be assigned to anyone and reassigned at any time and is an important part of your family's financial plan, regardless of your age or health. POA documents are available free of charge at CMBA | Lawyer Referral Service (LRS) or, contact our Volunteer Team if you wish to speak with one of our volunteer attorneys at no cost to you.

Planning for the future and making your health care wishes known is one of the best gifts you can give your loved ones today. Visit our Advance Care Planning page for helpful information.​​​

​​How Long Can You Receive Hospice Care? ​

Patients can receive hospice care as long as the doctor and the hospice medical director continues to certify they are terminally ill with six months to live or less, if the disease runs its normal course. Many hospice patients are "recertified," remaining in hospice care longer.