Hospice Care
Hospice care is a specialized medical service designed for terminally ill patients for whom curative treatment is no longer the primary goal. The focus shifts from curing the underlying disease to ensuring the patient spends their remaining time with dignity, comfort, and peace. This palliative medical service (comfort care) model prioritizes expert symptom management while providing comprehensive psychological and spiritual support for both the patient and their families.
Service Types and Settings
Hospice is a philosophy of care rather than a specific physical location; it is designed to meet wherever they reside.
- Settings: Patient’s home (most common), assisted living facilities, nursing homes, dedicated hospice facilities, or hospitals. Hospice service also may be provided in hort-term inpatient hospital.
- Team-Based Care: A multidisciplinary team consisting of doctors, nurses, social workers, counselors, and volunteers works together to address the physical, emotional, social, and spiritual needs of the patient and their family.
Cost and Coverage
Medicare (Part A)
Eligibility Requirements (Must meet all conditions below):
- Terminal Diagnosis: The hospice medical director and the patient’s attending physician (if applicable) must certify that the patient has a life expectancy of six months or less, assuming the illness runs its normal course. If the patient does not have a primary physician, the hospice medical director can provide the certification alone.
- Transition of Care: The patient must sign an Election Statement choosing hospice care for their terminal illness instead of other Medicare-covered curative treatments.
- Certified Agencies: Services must be obtained through a hospice provider officially certified by Medicare (CMS).
*Benefit Periods: Medicare hospice benefits are available for two 90-day periods, followed by an unlimited number of 60-day periods. Even after six months, care can continue in 60-day increments provided the physician recertifies the patient.
*Medicare Hospice Out-of-Pocket Costs:
- General Covered Services: $0 (No deductible)
- Prescription Drugs for Pain Relief (Outpatient): Copay of $5 or less per prescription
- Inpatient Respite Care: 5% coinsurance of the Medicare-approved amount for short-term stays
LTC Medicaid (MLTSS)
- Benefit Scope: Provides comprehensive coverage (with zero or minimal cost-sharing) for professional nursing, physician services, medications for symptom management, and medical equipment.
- Room and Board: For residents in nursing homes, room and board costs may be covered if the individual separately meets Medicaid eligibility requirements. Since regulations vary by state, verification is required.
*For details, check LTC Medicaid (MLTSS).
Hospice Care within Nursing Facilities
In instances where a resident receives hospice care while residing in a nursing home, a distinct cost-sharing structure applies:
- Hospice Medical Expenses: Medicare provides full coverage for all clinical hospice services.
- Nursing Home Room and Board: Medicare does not cover room and board costs. These expenses must be paid out-of-pocket, unless the individual qualifies for Long-Term Care Medicaid, which may provide financial assistance for those meeting specific eligibility criteria.
Veterans Affairs (VA) Benefits
U.S. military veterans can receive hospice care through the VA healthcare system.
- Eligibility: All veterans enrolled in the VA healthcare system are eligible for hospice care if clinically determined to need it. This benefit is provided regardless of service-connected disability ratings or income levels. (Procedures for enrolling in the VA healthcare system can be found at VA.gov).
- Cost Sharing: There is no copayment (Copay) for services provided by the VA or VA-contracted agencies.
- Locations: Care can be received at home, in VA outpatient clinics, VA inpatient facilities (including Community Living Centers), or through VA-contracted community hospice providers.
*For instructions on how to enroll in the VA health care system, please visit VA.gov.
Private Health Insurance and Long-Term Care (LTC) Insurance
- Private Plans: Most private insurers mirror the Medicare hospice model. However, patients may still be responsible for deductibles or copayments.
- LTC Insurance: Depending on the specific policy, this may cover hospice costs in a nursing home or at home within a set daily limit.
Charity Care / Uninsured
This serves as the final safety net for individuals without insurance who face financial hardship.
- Many non-profit hospice agencies offer care at no cost or at a discounted rate through community donations or foundation funds.
- Sliding Scale: Costs are adjusted based on the patient’s income and asset levels.
*If hospice care is required while uninsured, please inquire about financial assistance options through non-profit hospice agencies or a designated social worker. (For inquiries regarding NJ Charity Care, contact 1-866-588-5696.)
Prescription Drug Benefit (Medicare Part D) — Separate Medicare Benefit
As of 2026, the annual out-of-pocket cap for prescription drugs covered under Medicare Part D is limited to $2,100. After reaching this limit, the enrollee pays nothing for covered drugs for the remainder of the year.
*Note for Hospice Patients: Medications related to the terminal illness are already covered under the Medicare Hospice benefit with a maximum copay of $5. The Part D $2,100 cap primarily applies to medications unrelated to the terminal illness. Additionally, plan premiums and drugs covered under Part B (such as certain injectables) are not included in the calculation toward this cap.
Prescription Drug Benefits (Medicare Parts A and D) — For Medicare Beneficiaries
- Medications Related to Terminal Illness: These are covered under Medicare Part A. Beneficiaries are responsible only for a copayment of up to $5 per prescription.
- Other Prescription Drugs: Medications unrelated to the terminal illness are covered under Medicare Part D. The annual out-of-pocket cap is $2,100, and the 2026 Part D standard deductible maximum is $615.
- Medicare Advantage (Part C) Enrollees: You may maintain your existing prescription drug coverage through your current plan without the need to enroll in a separate Medicare Part D plan.
- Extra Help (Low-Income Subsidy): Beneficiaries also enrolled in Medicaid may qualify for the Extra Help program, which significantly reduces or eliminates the cost of medications for conditions unrelated to hospice care.
Find a Hospice Care Facility
*Hospice care is voluntary. You can stop hospice services at any time to return to curative treatment and may re-elect hospice benefits again in the future if needed.
Korean-Speaking Hospice Care Facilities in Bergen County, NJ
Considerations for Selection
- Check the 5-Star Quality Rating: Review the 5-star ratings for each facility on Medicare.gov Care Compare. The rating consists of three domains:
- Health Inspections
- Staffing
- Quality Measures
- Review Survey Reports: Request the most recent state inspection report kept at the facility, or view it online via Medicare.gov Care Compare and state government websites.
- Consult the Long-Term Care Ombudsman: The Long-Term Care Ombudsman is an independent advocacy agency appointed by the Governor to protect the rights of residents in long-term care facilities and investigate reports of abuse, neglect, or complaints. The Ombudsman is the direct, confidential line for intervention and protection for residents, family members, or concerned parties.
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