Is There a Cost?
Hospice care is covered by most insurers, including Medicare, Medicaid, Blue Cross/Blue Shield and most commercial insurers and HMOs. Hospice is a covered benefit under Medicare for people who have a life expectancy of six months or less. Medicare will pay 100% of all hospice team services, medications, durable medical equipment, and medical supplies related to the terminal illness and/or prognosis. Room and board costs in a facility are considered custodial care and are not covered under the Medicare hospice benefit. Occasionally, other insurers will cover room and board costs. For non-Medicare patients, any applicable patient pays, spend-downs, co-pays, or deductibles will apply.
However, Hospice of Michigan accepts everyone who needs and seeks our services regardless of your ability to pay, and we are always willing to work with our patients and families to insure there is open access to our program.
The following conditions must be met in order to be eligible for reimbursement from Medicare, Medicaid or insurance:
- Progressive disease with increasing symptoms and/or worsening lab values and/or decreasing functional status and/or evidence of metastatic disease, particularly brain.
- Stage IV at initial diagnosis; Stage III with pleural effusion; or Stage II with patient continuing to decline despite definitive therapy.
- Karnofsky Performance Status < 70 or Palliative Performance Score < 70%
- Significant hemoptysis
- Superior vena cava syndrome
- Lymphangitic lung involvement
- Recurrent pneumonia (two or more episodes in three months)
- Laboratory abnormalities:
- LDH > twice normal
- Albumen < 2.5
- Calcium > 14
- Weight loss of five percent or more in the last three months due to progressive disease, or irreversible dysphagia or loss of appetite.
- Presence of severe co-morbidities that contribute to a life expectancy of six months or less, including but not limited to:
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Diabetes mellitus
- Neurologic disease (CVA, ALS, MS)
- Renal failure
- Liver disease
- Acquired immune deficiency syndrome (AIDS)
- Recurrent disease after surgery/radiation/chemotherapy.