In 2013, Medicare covered 87 percent of hospice care patients and Medicaid covered about 4 percent of claims, with private insurance, charity, or self-pay accounting for the remaining 9 percent of claims, according to NHPCO data. As a Medicare beneficiary, hospice care is available to patients who receive a diagnosis from their physician and medical director that they have six months or less to live if the terminal illness runs its normal course.

Patients or their personal representatives also must sign a statement that they understand that hospice care provides palliative rather than curative therapies and forego Medicare coverage of treatments designed to cure the terminal illness. (At any time, however, a patient can discontinue hospice care enrollment and revert back to Medicare coverage for treatments aimed to cure a disorder.)

From there the hospice team is tasked with setting up a plan of care for the patient with a range of services that might include a team of health care specialists including the patient’s personal physician; a hospice physician; nurses; hospice aides; social workers; bereavement counselors; clergy or other spiritual counselors; speech, physical, and occupational therapists; and volunteers.

Medicare benefits start with two 90-day periods of enrollment followed by an unlimited number of 60-day periods. At the end of each period, the providers at the facility must conduct an in-person visit to recertify a patient for continued enrollment in the care.

Medicaid, private insurance plans, health medical and other managed care organizations have similar certification policies. Patients and their families also can hire a hospice care provider and pay out of pocket for the services.