Cost and Eligibility

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Most families are surprised to learn that the care provided by hospice is covered by most private insurance plans, and almost entirely covered by Medicare.

Cost and insurance coverage

Hospice is one of very few services that are covered up to 100% by Medicare and Medi-Cal. for many families, this means there is no deductible and there are no co-payments. Provided other eligibility requirements are met, Medicare and Medi-Cal will pay for home visits and all medications, supplies, and equipment related to easing pain or uncomfortable symptoms. In most instances, Medicare and Medi-Cal will even pay for several days a month in a nursing home if family members need a break. Medicare and Medi-Cal may even pay for hospice services provided in conjunction with a longer nursing home stay. Contact us at 866-996-2172 (toll-free) or admin@sangabrielhospice.com for more information. For individuals with private insurance, check with your insurance carrier regarding hospice benefits. Typically they cover the same services, medications, supplies, and equipment as the Medicare program. Some follow the same eligibility requirements as Medicare; others have their own eligibility criteria.

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Eligibility Requirements

Currently, the legislature has established very specific criteria for Medicare and/or Medi-Cal recipients to receive full hospice coverage.

  • A doctor must prescribe hospice on the basis of his/her belief that the patient is unlikely to live more than six months. (This does not mean that the patient is going to die in six months. Many hospice patients live for months or even years longer! It simply means that the patient has a serious, life-threatening condition.)
  • The patient prefers a focus on staying comfortable rather than a focus on cure. The typical hospice patient is an individual whose emphasis is on quality of life. Instead of dealing with curative therapies and their often exhausting and distressing side effects with slim chance of success, hospice patients choose to let nature take its course. They focus on medications and therapies that will allow them to comfortably engage in the activities they enjoy for as long as possible. Medicare will not pay for curative care and hospice care at the same time.

Private insurance companies often mirror Medicare and Medi-Cal’s eligibility requirements, although a very few will pay for curative and hospice care simultaneously, especially in the case of seriously ill children. Check with your insurance carrier to find out about their criteria, or give us a call at 866-996-2172 (toll-free).

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