There are several methods of payment for hospice services, including Medicare, Medicaid and private health insurance. Typical hospice benefit descriptions are as follows:

Medicare Hospice Benefit

The Medicare Hospice Benefit provides comprehensive coverage for hospice care. Medicare beneficiaries who have coverage under Medicare Part A and meet eligibility for hospice care can access the Medicare Hospice Benefit. Rainbow Hospice is reimbursed at a daily rate for Medicare Hospice Benefits.

The Medicare Hospice Benefit reimburses Rainbow Hospice at a daily rate for all of the services. (See Rainbow Hospice’s Services)

1. The Medicare Hospice Benefit allows for short-term respite, special care and inpatient hospice admissions when deemed appropriate.
2. Medicare Part A will be used to cover services related to the life-limiting illness during the time the patient uses the Medicare Hospice Benefit. The patient still has access to services covered under Medicare Part B that are not related to the terminal illness.
3. All Medicare paperwork and billing pertaining to the life-limiting illness is handled by hospice.

Medicaid Hospice Benefit

Medicaid is a state-funded program that provides medical coverage for persons who have limited financial means and who meet the eligibility requirements for hospice care.

1. The Medicaid Hospice Benefit reimburses Rainbow Hospice at a daily rate for all of the services. (See Rainbow Hospice’s Services)
2. All Medicaid paperwork and billing pertaining to the life-limiting illness is handled by hospice. Hospice staff will verify coverage and assist individuals in applying for Medicaid.
3. Spend-down amounts must be satisfied in order to access maximum coverage under the Medicaid Hospice Benefit.

Medicare HMO Coverage for Hospice

If an individual is enrolled in a Medicare-approved HMO, electing hospice is simple.

1. The Medicare HMO transfers coverage to Medicare Part A for hospice benefits. (See Medicare Hospice Benefit)
2. The Medicare Hospice Benefit reimburses Rainbow Hospice at a daily rate for all of the services.
3. Under a Medicare HMO plan, an individual has freedom of choice in selecting the hospice provider, even if it is outside the HMO provider network. This makes choosing Rainbow Hospice easy.

Private Health Insurance Coverage for Hospice

Hospice benefits vary widely among insurance plans. Rainbow Hospice will verify and negotiate benefits for people with commercial or private health insurance.

1. Coverage will be determined at the time of admission to hospice and the allowable benefits will be explained.
2. In most situations, Rainbow Hospice is able to negotiate a daily rate that provides coverage for hospice services.
3. As with any healthcare benefit plan, deductibles and co-payments may be applied to the hospice benefit.

Hospice Coverage for the Uninsured

Rainbow Hospice is a nonprofit organization committed to serving the needs of its community. If a patient does not have any of the coverage mentioned above, Rainbow Hospice will provide services based on need, regardless of one’s ability to pay.

Coverage for Services Unrelated to Hospice Care

There may be occasions when the patient requires medical services unrelated to the life-limiting illness that are not covered by the hospice benefit. Insurance coverage for these services will be based on the type of health insurance policy the patient has. Please consult with your Rainbow Hospice representative for further explanation.

Discontinuation of Hospice Services

The patient can choose at any time to discontinue hospice care. On occasion, individuals may choose to receive active treatment or alternative medical benefits instead of hospice care. With proper notification to Rainbow Hospice, this transition can be easily accomplished for the patient. Medicare, Medicaid and most private health insurance plans allow for hospice benefits to be reactivated at a later date.