One of the cruelties, or at least absurdities, of dying is that while dealing with the emotional realities of death, you still must concern yourself with the bureaucratic realities of our modern society. Nothing is free, and everything comes with paperwork. During the most challenging times in your life, when you or a loved one are considering hospice care and your options for the end of life, there are forms to fill out and money to worry about.
People who are facing their own death, or that of an older loved one, must ask themselves about hospice. There are many reasons to choose hospice, especially home-based hospice. Making the decision to accept the end is an emotional hurdle, but once you pass that, there are still many questions: What kind of hospice do you want? Where do you want to be? And, of course, how will you pay for it?
Paying for hospice is an important part of the equation. You want to be able to not worry about money as you near the end of your life and not have banal fiduciary concerns occlude your goodbyes. You want to be able to take the journey unencumbered. That’s why you need to know the ins and outs of the treatment and know who pays for hospice care at home in California.
Many Layers of Help for Paying for Hospice Care at Home
During the Obama administration, a new regulation was passed that allowed your Medicare funds to move with you. That is, if you went from a hospital to a nursing facility to home, you could still use your funds so long as they were spent on health. That made going home easier for people who didn’t require long-term or permanent stays in a facility.
One of the outcomes of that, as well as shifting cultural norms, has been a large growth in at-home hospice services. They are now easier to pay for and that’s made a huge difference. In 2010, approximately 19% of hospice patients were at home. Now, some estimate that number has doubled.
There are many ways to pay for hospice in California. Here are a few of them:
Medicare: This is the largest single-source of hospice payments in California and America. If you or your loved one is using a Medicare-certified provider, Medicare will pay up to 100% of the costs. Of all hospice patients, 84% use a Medicare-certified provided. (Please go here to find a Medicare-certified hospice provider near you.) In case you are wondering what that entails, Medicare will cover:
- Nursing care
- Counseling/social services
- Physician care
- Homemaker aid
- Medical supplies (including medicine)
- Physical therapy, occupational therapy, and speech language pathology
- Bereavement services for families
Medi-Cal: This is similar to Medicare and offers similar services for people residing in California. People are eligible for Medi-Cal if they are at less than 138% above the California poverty line. There is a graded scale for the size of your family to determine eligibility. You are also eligible if you are over 65, blind, disabled, or under legal refugee status.
TRICARE: TRICARE is a program that provides health insurance through the Department of Defense. You are eligible for TRICARE if you are:
- Uniformed Service members (including active duty and retired members of the U.S. Army, Air Force, Navy, Coast Guard, Marine Corps, the Commissioned Corps of the U.S. Public Health Service, and the Commissioned Corps of the National Oceanic and Atmospheric Association and their families)
- National Guard/Reserve member and their families
- Surviving spouses
- Medal of Honor recipients and their families
- Others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
Charity: For people who are not eligible for Medicare, Medi-Cal, or Tricare, have no access to these programs, or have expenses that these programs will not cover, there are also charitable services in California that help pay for or run hospice programs. These are generally run through the hospice program itself, through grants and private donations. Medicare law states that no one can be denied hospice care because of inability to pay.
Private: Some people, less than 3% of patients, choose to pay for hospice out of pocket, usually due to wanting to go outside the Medicare-approved system (for religious or spiritual reasons) and having the financial capability to do so.
Getting Help with Paperwork
Remember that, as in all things, you are not alone when it comes to handling the financials of hospice care. You might feel bewildered, confused, and unable to handle the paperwork and the process that comes with this. You may be grief-struck or sorrow-drowned, and going through the motions of the everyday. Or you may be trying to soak up as much time in this world with your loved ones as possible, and want to ignore paperwork.
But there will come a time when it has to be done, and the sooner you do it, the more time you have to not worry about it. Thankfully, there are services available to help you manage the financial aspect of at-home health and hospice care. There are financial services available for aging adults that can help with matters of money management, including medical insurance filing. Community Living Services specifically serve individuals making the transition out of a facility and back to living at home and in the community. There are also many hospice foundations also can help you through the paperwork and the bureaucracy of lining up at-home hospice care funds.
Hospice at home can be a way to leave this earth comfortably, with dignity, on your own terms, surrounded by the ones you love in a setting that has meaning and memory for you. It’s an option that is worth looking into, especially because Medicare, Medi-Cal, and other programs make it affordable and accessible for Californians. Where you die is a choice that not everyone can make. But if you can, don’t let paperwork frighten you. Look into your options, and do what is right for you. You deserve it.
At Institute on Aging, we help older adults age in place, with dignity, respect, and adventure. Our programs and services help aging adults carry out their end-of-life wishes with their families and caregivers at their sides. Connect with us today to learn more.