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Paying for Palliative and Hospice Care

Medicare Hospice Benefit

Medicare’s “Hospice Benefit” pays for hospice care for people who are terminally ill and have a life expectancy of six months or less, if the illness runs its normal course.

Coverage for Hospice Care

The Medicare Hospice Benefit is an inclusive benefit, in which all services that are related to the terminal illness are completely covered by Medicare part A.
Medicare Hospice Care Coverage Includes:
  • Nurse visits
  • Physician visits
  • Other healthcare professional visits
  • Therapy
  • Medication
  • Supplies
  • Social Work
  • Spiritual Care
  • Bereavement support
  • * Arts services
  • Supplies
  • Social Work
  • Spiritual Care
  • Bereavement support
  • * Arts services

* Connecticut Hospice covers all costs of Arts services, which are not reimbursed to us by Medicare.

You must still pay your regular Medicare Part A and B premiums, and any other care that is unrelated to the terminal illness will continue to be covered.

Hospice Eligibility

At this time, patients must meet two important conditions to be deemed eligible for the Hospice Benefit by Medicare:

A Hospice doctor and the patient’s attending physician (if any) must certify that the patient is terminally ill with an expected prognosis of less than 6 months.

The patient has elected to cease curative treatment and chosen to focus only on comfort and quality of life.

As a Medicare-certified hospice, Connecticut Hospice and its programs qualify for Medicare Hospice Benefit.

Doctor speaking with male Palliative Care patient in a hospital bed at The Connecticut Hospice

Coverage for Palliative Care

Patients in our Stand By Me (SBM) home care program are eligible for home palliative care services, including physician or nurse practitioner consultation in the home to assist with symptom management and decision making in serious illness.

Medicare coverage for palliative home care is available under certain conditions, where skilled care is needed for patients who are homebound, as certified by their physician.   

Regular Medicare covers inpatient palliative care for symptom management for our SBM patients. At this time, those with a Managed Medicare policy are excluded from palliative care admission to our Branford Inpatient facility.

Palliative Care

Coverage for Respite Care

Respite care is only available for Hospice patients for short-term (5 days or less) inpatient stay.  Medicare and Medicaid Hospice cover Respite Care.  Patients should check with their private insurance to see if this benefit is covered.  

Learn more about Respite Care eligibility requirements.

Respite Care
Daughter bringing her elederly mother in for temporary respite care at The Connecticut Hospice

Contact Your Insurance Representative

In addition to Medicare and Medicaid, many insurance companies cover palliative and hospice care. Each patient situation is different, so we recommend you contact your insurance company, or a Medicare/Medicaid representative to determine your coverage and to find out about any possible copays or deductibles.

A Detailed Breakdown of Paying for Hospice Care:

The Connecticut Hospice is a Medicare/Medicaid certified hospice program, offering a comprehensive hospice benefit. Most of our patients are Medicare/Medicaid eligible. You do NOT have to be over 62 to qualify for Medicaid.

Hospice care services are paid for by Medicare, Medicaid, most commercial insurances and privately by the patient/family.

Once a diagnosis is given and a patient is determined eligible for hospice care, the hospice benefit can be elected. The hospice benefit pays for all medical care, medications and appropriate treatments that will provide comfort and alleviate symptoms and which are related to the diagnosis. Hospice cares for people wherever they live. Because of that, hospice care is provided in hospitals, nursing homes and assisted living communities as well as in private homes.

We know that health care payment can be complicated, the following is a guide to help you understand Medicare/Medicaid coverage. (If using commercial insurance, please check with the company.)

Hospice care is covered by Medicare and Medicaid, Part A, B and C.

What part of hospice care does Medicare/Medicaid cover?

Physician services

  • Durable medical equipment (such as beds or walkers)
  • Medical supplies 
  • Medications for symptom control or pain relief
  • Nutritional/dietary counseling
  • Hospice aide
  • Social worker services
  • Short-term inpatient care (for pain and symptom management)
  • Short-term respite care (may need to pay a small copayment)
  • Extended or continuous care
  • Grief and loss counseling for the family

In most cases, supplies, equipment and even medications can be delivered to the patient's residence. Medicare supplements may help pay for particular aspects of care not fully covered by Medicare.

What you will be responsible for:

  • Your Medicare co-pay
  • Commercial Insurance co-pays and deductibles
  • Nursing home room and board (if applicable)
  • Transportation costs between facilities
  • Prescription co-pays--(If on Medicare/Medicaid, your loved one will pay no more than $5 for each prescription drug and other similar products for pain relief and symptom control.)
  • Respite care room and board fees, if not a Medicare patient
  • 5% of the Medicare-approved amount for inpatient respite care--(For example, if Medicare pays $100 per day for inpatient respite care, your loved one will pay $5 per day. He or she can stay in a Medicare-approved hospital or nursing home up to 5 days each time he/she gets respite care.)
  • Treatments or medical supplies outside of the hospice plan of care 
  • Patients and/or patient families may be responsible for some costs associated with hospice care.

Contact The Connecticut Hospice, 203-315-7500 ext. 540 to make sure you understand what your responsibilities are with regard to payment.

Medicare and Medicaid Reimbursement Rates and Regulations

Unlike many medical treatments which vary in cost according to location or hospital system, the Medicare reimbursement for hospice care is fixed at a daily rate, regardless of the complexity of the care involved in assuring the patient's comfort. There are four hospice reimbursement rates, and they are linked to what are called the "four levels of care": routine home care, general inpatient care, respite care, and continuous care. For additional information about Medicare and Medicaid and the hospice benefit, please visit Medicare/Medicaid (http://medicare.gov/coverage/hospice-and-respite-care.html).

Commercial Insurance and the Hospice Benefit

Most commercial insurers, such as those offered through an employer, also offer a hospice benefit. Because insurance plans vary, it is important to speak with your insurance provider (and supplemental insurance provider) as well as The Connecticut Hospice to fully understand your financial obligations.

Patient Self-pay and Financial Assistance

Some palliative care or hospice patients are self-pay. While this is unusual, it may happen that private insurance coverage is inadequate, and they do not qualify for federal insurance programs. Rather than wait, the patient or family may choose to pay for some or all services directly. There are set fees for all services. Interest free payment plans can be arranged.

Our Care Promise

There may be special circumstances where The Connecticut Hospice patients and families need financial assistance. Circumstances such as:

  • You do not have medical insurance
  • Your medical insurance does not cover hospice or palliative care services
  • Your medical insurance has limited coverage
  • You completed a Medicaid application and are waiting for approval and/or you do not qualify

A Social Worker is available to conduct a financial assessment and help answer questions regarding your options. For an appointment call: 203-315-7500 ext. 692. You and/or your family will be asked to provide documentation of financial need.

Help Us Help Others

In order to cover unreimbursed services and continue serving patients regardless of ability to pay, The Connecticut Hospice relies on memorial gifts, private donations, community support and grants. We sincerely appreciate all gifts and pledge to use all donated funds in service to our patients and our communities.

Donate  Online

Please Support Us

As a not-for-profit, we depend on generous donors to help us provide customized services and therapies that aren’t completely covered by Medicaid, Medicare, or private insurance. 

Please make a gift to help us sustain the highest standard of care.

Donate  Online

Contact Admissions

Admissions may be scheduled seven days a week.
Call our Centralized Intake Department: (203) 315-7540.

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