Insurance Obstacles for Palliative or Hospice Care

As most of us are aware, there are always Insurance Obstacles in life. Some would call insurance the bane of our existence.  We need it but it is painful to navigate and ensure we are getting what we pay for.  In this blog we’ll touch on a few heads up issues when heading into Hospice Care or Palliative Care.


Hospice Care

Medicare  – Coverage for eligible beneficiaries includes those with terminal illnesses who are receiving care from a medicare certified hospice program.  Medicare covers ll aspects of hospice, medical services, pharmaceuticals, and supportive services.

Medicaid  – Also covers hospice beneficiaries, however coverage can vary by state.  You must check with your local state medicaid office.

Private Insurance  – Many plans, included employee sponsored and individual plans, cover hospice care.  The scope of your actual coverage may vary greatly and some may also require copayment or coinsurance.  Check with your insurance representative to validate your coverage.

Veteran Administration  – VA provides hospice care to eligible veterans including those with terminal illnesses.


Palliative Care

Medicare  – Medicare covers palliative care when they are provided in conjunction with other medical services such as chemotherapy and/or radiation treatments.

Medicaid  – Medicaid is also regulated by the state you are in so you much check in with the state Medicaid office to ensure you receive accurate information about your coverage before you seek services.

Private Insurance  – Private Insurance often covers palliative care. The scope of coverage may vary for each individual case and some may also require a copayment and/or coinsurance.

Workman’s Comp  – Some benefits may be provided to those who may have been injured on the job.



Gaps in Coverage  – some insurance plans may not cover al aspects of hospice or palliative care such as medicine or supportive services.

Copays  – Depending on coverage you may be required to pay a copayment for the services

Limited Access  – Patients may experience a problem with limited providers in their area.  This may be due to limited availability and/or reimbursement issues.

Pre-Authorization  – Also, some plans require pre-authorization for certain services or medicines.  This can create a delay, and/or barriers to care.


Tips for Navigating Insurance Coverage

  • Check your insurance plan documentation.  Review your policy to ensure you understand what isInsurance Obstacles covered and what is not.
  • It goes without saying, check in with your insurance agent/provider and ask about specific coverage questions or concerns.
  • Ask about network providers.  Ensure they are currently available under your plan.  Find out which providers are part of your network to ensure that covered services will be available for you.
  • Seek assistance from patient advocate. If struggling to navigate the system, ask for help from a patient advocate or social worker.
  • Essentials too understand coverage and limitations
  • Before you are requesting or receiving services, be sure to get the help you need to be thoroughly aware of your coverage.  By doing so, you can ensure you receive necessary care and support during these challenging times.

Be sure to give us a call if looking for Hospice Care or Palliative Care.  We may be able to help!