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What Are the Requirements for In-Home Hospice Care?
Date Updated: December 16, 2024
Written by:
Lauren Ferguson has over five years of experience as a freelance writer, specializing in senior care topics such as assisted living and memory care. She holds a degree in Liberal Studies and English from the University of Illinois Springfield. Having navigated the process of placing her mother in a long-term care community, Lauren offers a unique insider's perspective to families facing similar situations.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
The requirements for in-home hospice care include a diagnosis of a terminal illness with a life expectancy of 6 months or less, as certified by a physician, and a signed statement agreeing to forgo curative treatments. However, specific eligibility criteria vary depending on the individual's insurance provider.
Insurance Coverage for In-Home Hospice Care
In-home hospice care provides support for people facing terminal illnesses, focusing on pain management and emotional support during the final stages of the patient's life. Although most people pay for this service through Medicare, some individuals and families look into alternative ways to cover their expenses. Options include:
- Medicaid: The specific services Medicaid pays for vary by state. The program typically covers individuals with limited incomes.
- Private Insurance: Hospice care coverage under private plans differs significantly. Contact your insurance provider for more information.
- VA Benefits: The Department of Veterans Affairs offers hospice care benefits without any co-payments for eligible veterans.
- Out-of-Pocket Payments: Some families choose to pay for hospice care directly in full or to supplement existing coverage.
Requirements for each option vary, so consult with a health care provider or insurance representative to clarify individual eligibility and coverage details.
Who Qualifies for In-Home Hospice Care Through Medicare?
Individuals must first verify their eligibility for Medicare Part A. This part generally covers U.S. citizens who are ages 65 or older, have a qualifying disability or suffer from end-stage renal disease. Once enrolled, for a patient to receive in-home hospice care benefits:
- A physician must certify the patient has a terminal illness with a life expectancy of 6 months or less.
- The patient must agree to receive hospice services over curative treatments. This decision involves signing a statement acknowledging the focus on comfort care rather than curing the illness.
- The patient must choose a Medicare-approved hospice provider.
Medicare covers the full cost of most services provided by in-home hospice care, including skilled nursing, therapies and counseling. However, patients still have to pay a small fee for prescription drugs for pain management and part of the expenses incurred for inpatient respite care.