Hospice is covered by Medicaid in most states but is not a mandatory Medicaid benefit.
Medicaid programs are administrated at the federal level and by each individual state. There are certain mandatory benefits that the federal government requires all state Medicaid programs to cover. Some benefits, however, are optional benefits. This means one state Medicaid might cover an optional benefit, while another state may not cover the same benefit. Among those state-optional benefits is hospice care.
In this guide, you can get a better understanding of how Medicaid hospice coverage typically works in states where it’s a covered Medicaid benefit.
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Hospice is care and comfort provided to a person during the final weeks or months of their life. For a person to be placed in hospice care, they must be certified by a doctor as “terminally ill” or have a medical prognosis that will result in a reduced life expectancy.
Hospice care involves treating symptoms of the disease but not the disease itself. The goal of hospice care is to bring comfort to the patient during their final days, not to cure or treat their disease.
While each state Medicaid program’s hospice coverage can vary, any state Medicaid program that includes hospice care must follow several federal mandates, including.
Eligibility requirements can vary by state, but some of the typical requirements you might be subject to in your state can include:
Each state Medicaid program decides how long the program will pay for hospice care. States establish their own standards as to how much life expectancy a patient may have left before Medicaid hospice care coverage kicks in.
However, as noted above, any state that chooses to cover hospice care must do so for at least 210 days (roughly seven months).
Medicaid hospice benefits will vary by state, but most state Medicaid programs that cover hospice will cover hospice care in your home, in a nursing home, assisted living facility or rehabilitation center.
Medicaid beneficiaries receiving covered hospice services are not subject to any deductibles, copayments or coinsurance. Room and board are fully covered during hospice care if the beneficiary is residing in a nursing home or assisted living facility.
Medicare Part A covers hospice care for beneficiaries who meet the program’s eligibility criteria.
Medicare does not cover the cost of room and board for a hospice patient living outside of their own home and may require small copayments for medications designed for pain or symptom relief along with small coinsurance payments for respite care. These copayments and coinsurance may be covered by some Medicare Supplement Insurance (Medigap) plans.
Medicare covers hospice care much like some Medicaid programs cover hospice, with no deductibles, copayments or coinsurance. Medicare requires a life expectancy of six months or less to determine when hospice benefits may begin.
Additional hospice benefits may be available in some Medicare Advantage (Medicare Part C) plans. A Medicare Advantage plan that includes prescription drug coverage or a Medicare Part D prescription drug plan may be able to offer additional coverage for medications used during hospice care.
You can contact your state’s Medicaid program directly and inquire about the hospice care benefits available in your state, including eligibility requirements.
Medicaid beneficiaries who are also eligible for Medicare may be able to enroll in a certain type of private Medicare plan called a Medicare Advantage Special Needs Plan. These plans are designed for people with certain health, living or financial circumstances, and one of the available plans is a Dual-eligible Special Needs Plan (D-SNP). D-SNPs are for people enrolled in both Medicare and Medicaid at the same time.
If you are eligible for Medicare, speak to a licensed insurance agent to find out if Dual-eligible Special Needs Plans are available in your area and how they might cover hospice care and other benefits.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
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