Paying For Hospice Care

Who pays for hospice care?

Hospice is paid for by Medicare, Medicaid, and most Private Insurance plans. Additionally, St. Croix Hospice does not discriminate based on an individual’s ability to pay for services. As necessary, we have knowledgeable social workers available to assist with financial counseling.

Hospice is a comprehensive benefit that covers the following items as they relate to your hospice diagnosis:

  • Durable Medical Equipment
  • Medications related to comfort and your hospice diagnosis
  • Supplies

Medicare Hospice Benefit

For Medicare beneficiaries, hospice services are covered under Medicare Part A. You are eligible for the Medicare hospice benefit when:

  • You are eligible for Medicare Part A
  • Your doctor and hospice medical director certify that you are terminally ill, and probably have less than six months to live.
  • You sign a statement choosing hospice services instead of routine Medicare covered benefits for your terminal illness.
  • You receive care from a Medicare approved hospice program.

Medicaid | Medical Assistance Hospice Services

The state Medicaid program determines your eligibility, which is limited to individuals who fall into certain categories. Medicaid is a state-administered program and each state sets its own guidelines regarding eligibility. The hospice service benefit is an optional benefit, which states may choose to make available under the Medicaid program. The purpose of the hospice benefit is to provide for the palliation or management of the terminal illness and related conditions. Under federal guidelines, the hospice benefit is available to individuals who have been certified terminally ill by a physician. A hospice must meet the Medicare Conditions of Participation in order to receive payment under Medicaid.

St. Croix Hospice will provide services for care of the patient’s life-limiting illness directly through contracted services. During the patient’s hospice benefit period, St. Croix Hospice, through Medicare or eligible Medicaid programs, will cover the patient’s full financial responsibility for these services, except under any of the following circumstances:

  • If the patient decides to pursue a curative, non-palliative course of treatment.
  • If the patient enters an inpatient facility without prior authorization from St. Croix Hospice.
  • If the patient enters an inpatient facility for a condition unrelated to his/her primary hospice diagnosis.
  • If the patient enters an inpatient facility that does not have a contract with St. Croix Hospice to provide care to St. Croix Hospice patients.
  • If the patient receives the same type of care from a different provider, unless you change your provider.

The Medicare and Medicaid hospice benefit provides for four levels of care: Routine Home Care, General Inpatient, Respite Care and Continuous Care. Any changes in a patient’s level of care must be approved by St. Croix Hospice.

Dual Coverage Payment for Hospice Services

Medicaid reimbursement, related to hospice services, can help with paying for hospice care services that Medicare does not cover. If a Medicaid hospice patient resides in a nursing facility, the state must pay the hospice for the room and board services provided by the nursing facility.

Private Insurance Payment for Hospice Services

Various types of insurance plans cover many of the professional services offered by St. Croix Hospice. A St. Croix Hospice social worker is available to discuss insurance and assist the patient to receive the maximum available coverage for needed services. By speaking to your insurance company directly, St. Croix Hospice can better help the patient know exactly what is covered and what, if anything, will remain the financial responsibility of the patient. You will be informed orally and in writing before care is initiated regarding the extent of which charges the patient may have to pay.

After the insurance company makes its payments, if there is an uncovered balance payable to St. Croix Hospice, our staff will discuss this with the patient or family and charges will be billed directly. If a statement of services sent to a third party payer is not paid within 90 days of it being mailed, or if there is no third party payer that will reimburse St. Croix Hospice for services rendered, the patient will be expected to pay the outstanding balance.

St. Croix Hospice will never discontinue services because of a proven inability to pay.