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What is the cost and Who pays for it?
Reimbursement for hospice services comes from Medicare, Medicaid, HMO’s, private payors and other Private Insurance plans. Under Medicare/Medicaid in Wyoming, all services provided by the hospice team, medical equipment, such as hospital beds and pharmaceuticals related to the terminal illness are fully covered. (Although, hospices may collect a very low co-payment for pharmaceuticals.) Questions regarding the nature of the hospice benefit available within a particular insurance plan should be directed to the Insurer or to the hospice representative.
In 1983, congress expanded the Medicare insurance program to include hospice. To be eligible for this benefit, a physician must state in writing that, in his/her clinical opinion, the patient has less than six months to live if the disease runs its normal course. A physician must review the medical chart and restate his/her belief at certain intervals, known as, ‘benefit periods’. (two periods of  90 days each, followed by an unlimited number of 60 day periods.) The patient or representative must sign an elective statement indicating that he/she understands the nature of the illness and of hospice care. In addition to hospice services, the patient may continue to receive Medicare benefits not related to the terminal illness. In Wyoming, Medicaid provides a similar benefit to Medicare for each day.
In the Medicare/Medicaid systems, hospices are treated distinctly from other health care providers. During the time that a beneficiary is receiving hospice care, the reimbursement is based on a daily rate paid to the hospice program for each day, without regard to the specific services provided on any given day. Patients and families are spared the bills and payment notices, because the claims-filing and reimbursements occur directly between hospice and the payment source.
Many hospices offer care on a private pay, sliding-fee scale, or charitable basis for those who have insufficient insurance. Charitable care is provided through the generosity of grants, gifts, and donations to not-for-profit hospice organizations. For-profit hospices may have foundations to assist patients in need. Speak to your local hospice about these options.
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