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How is Hospice Care
Paid For?
Hospice care is available to anyone, regardless of insurance or financial resources. No one who needs our services is turned away because they cannot afford to pay for care.
Generous community support helps Hospice of Lancaster County, our community’s only not-for-profit hospice organization, provide quality care to all in need of hospice and bereavement services.
For most Hospice patients, the cost of hospice care is fully covered by the Medicare Hospice Benefit (under Medicare Part A, or hospital insurance). The Medicare Hospice Benefit provides a daily allowance to the hospice organization. In turn, the hospice organization pays for all medical services, medications, durable medical equipment, supplies and treatments related to managing your serious illness and approved as part of your individual plan of care. The hospice plan of care focuses on comfort, rather than curative, measures. To learn more about the Medicare Hospice benefit, click here.
Like Medicare, Medicaid and most private insurance companies also provide coverage for hospice care and services. Private insurance benefits, deductibles and co-insurance requirements may vary by plan and are therefore reviewed and communicated on an individual basis.
For those not eligible for coverage through Medicare, Medicaid or private insurance, or for those who desire services for symptom control while pursuing curative treatment, Hospice of Lancaster County offers our Fee Reduction Program. Supported by community donations, the Fee Reduction Program works to ensure that everyone in the community has access to quality care and comfort when coping with serious illness and loss.
The Fee Reduction Program determines a maximum out of pocket expense you may incur for hospice care and services based on your annual income. When your maximum out of pocket expense is met, staff visits will continue and are covered by community support.
Common Questions about the Medicare Hospice Benefit
Who is Eligible for the Medicare Hospice Benefit?
Medicare beneficiaries must meet the following criteria to qualify:
- You must have Medicare Part A.
- You must enroll in a Medicare-approved hospice program such as Hospice of Lancaster County.
- Your doctor and the hospice medical director must certify that you have a life-limiting illness with a probable prognosis of six months or less if the disease runs its normal course.
- You must sign a form indicating that you are electing your Medicare Hospice Benefit to cover the costs of services related to managing your life-limiting illness.
Will I will lose my Medicare coverage if I elect the Medicare Hospice Benefit?
Standard Medicare coverage for services unrelated to your life-limiting illness does not change and is not affected by electing the Medicare Hospice Benefit. Services related to your life-limiting illness and included in the hospice plan of care are covered by the Medicare Hospice Benefit in the form of a daily allowance issued to the hospice organization who then pays for the cost of these services.
Do I have to change doctors to receive care from Hospice of Lancaster County?
No. The Hospice of Lancaster County team works with your physician to provide Hospice care for you and your family.
Am I locked into using Hospice care once I elect the Benefit?
No, you are not. You may revoke the Medicare Hospice Benefit at any time without penalty. There is no loss of coverage or service days. You may also re-elect the Medicare Hospice Benefit at any time, provided you meet the qualifying criteria.
Is there a limit to how long I can receive Hospice care if utilizing the Medicare Hospice Benefit?
Since no one can predict the course of a serious illness, there is no limit on the number of days a patient can receive Hospice care. The Medicare Hospice Benefit consists of two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. Each benefit period requires medical certification of the life-limiting illness at the beginning of the period. The Medicare Hospice Benefit covers the cost of hospice care and service for every medically certified benefit period regardless of the patient’s length of stay in the hospice program.
What Costs are Covered?
When deemed directly-related to your serious illness, the following services are generally included in your hospice plan of care and are covered by the Medicare Hospice Benefit.
- Registered Nurses who are specially trained in pain and symptom management who make routine visits as needed
- Regular visits by Licensed Practical Nurses to provide personal care
- Social work and counseling services to provide emotional support for you and your family
- Chaplain services for you and your family
- Visits by trained volunteers
- Short-term inpatient care at the Essa Flory Hospice Center or other approved facilities
- Temporary respite care at approved facilities
- 24-hour on-call medical services
- Dietary counseling
- Durable medical equipment (for example: bedside commode, hospital bed, walker, wheelchair)
- Medical supplies (for example: wound care supplies, incontinence supplies)
- Prescription medications (specified in your Plan of Care)
- Physical, occupational and speech therapy
- Other treatments and services related to managing your illness
What if I become ill and need to be moved to a different setting for care?
The Medicare Hospice Benefit pays for inpatient hospice care in a hospice center, hospital, or skilled nursing facility. Hospice of Lancaster County offers the Essa Flory Hospice Center, Pennsylvania’s only freestanding hospice facility. The Hospice of Lancaster County team will work with you and your family to determine the best setting for you to receive inpatient care.
What if I am in a nursing home or an assisted living facility?
Your nursing facility and the Hospice of Lancaster County team will collaborate on your care. You will have the benefit of experts in long-term care working with experts in pain and symptom management as well as counseling. It adds up to the highest level of quality care for you and your family and, in come cases, Medicare may still provide coverage for Hospice care even while helping to cover the costs of a nursing home.
How can I learn more about this benefit?
You can find more information from the Center for Medicare Education at medicareed.org, or by calling Hospice of Lancaster County at 717-295-3900.
For further information, please contact
Hospice of Lancaster County at 295-3900.
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