Hospice costs: medications, equipment & room and board

What belongs in the hospice care plan

Medicare hospice includes services and items needed to manage the terminal illness and related conditions, such as nursing, symptom-management medicines, medical supplies, and equipment. Needs are individualized rather than a fixed shopping list. Ask the team to explain how each item supports comfort and who will arrange it. Medicare pays the hospice for covered care under the hospice benefit.

Possible Medicare copayments

Medicare hospice can charge up to $5 for each outpatient prescription for pain relief or symptom management. A patient may also owe 5% of the Medicare-approved amount for inpatient respite care, subject to the applicable limit. These are not the same as paying the full cost of hospice. Ask what charges, if any, your provider expects for your situation.

Room and board is a separate expense

Medicare generally does not pay ordinary room and board at home, in a nursing home, or in a residential hospice setting. Hospice-arranged short-term inpatient care for eligible symptom-management needs and inpatient respite are different. A building’s name does not establish coverage. Ask whether a stay is ordinary residential care or a covered inpatient level of hospice, and who is arranging it.

Ask before buying or replacing equipment

Describe what has become difficult, such as repositioning in bed or moving safely to the bathroom. Have the team assess the need and explain the appropriate equipment, delivery, and training. Hospices must teach patients and caregivers how to use provided equipment safely. Ask whom to contact for a malfunction and what arrangements apply if the patient changes location or leaves hospice.

• Before you purchase: Ask whether the hospice can provide or arrange the item. Keep any written explanation if an item is not covered.
• For prescriptions: Ask which pharmacy to use and whom to contact for refills. Do not stop a medicine or pay for a replacement without discussing the issue with the care team.

Plan separately for living costs and extra help

Write down housing charges and ask whether your family will need help between scheduled visits. If considering a paid caregiver or facility, request a separate description of services and charges. Texas Medicaid may help with nursing-facility room and board for eligible residents, but the arrangement and any individual contribution must be reviewed. Ask about that possibility before assuming the entire bill is private pay.

If a bill does not make sense

Keep the bill, the care agreement, and any benefit explanation together. Ask the hospice which service was billed, whether it relates to the terminal illness, and which payer should be responsible. Ask someone to explain any written coverage notice in plain language. Texas HICAP benefits counseling is another place to ask for help understanding the issue.