The time may come for some families to consider the need for hospice care, the focus of which is caring, not curing, medical conditions and providing end-of-life care in the patient’s home. In most cases, family members serve as the primary caregiver and decision maker regarding the care of their terminally ill loved one. Then, members of the hospice team will make regular visits to assess the patient and provide additional care or services as needed. California hospice care is covered under Medicare, Medi-Cal, most private insurance plans, and HMOs.
How do you plan to pay for California hospice care?
Hospice care can be paid for in a variety of ways. The most common types of coverage include Medicare, Medi-Cal (California’s Medi-Cal program), private insurance, TRICARE (health benefit program for military personnel), private pay and charitable care programs.
Medi-Cal and Medicare benefits for hospice care
Medi-Cal and Medicare are both healthcare assistance programs provided by the government. The purpose of these programs is to extend healthcare coverage to U.S. citizens who are 65 years old and older and to provide healthcare services to others based on their income or financial need. Although these programs are alike in some ways, the benefits and eligibility requirements are very different. Another difference is that Medicare is a federally-run program, but Medi-Cal is run by state governments.
How do I apply for Medi-Cal?
California’s Medi-Cal program, Medi-Cal, provides free or low-cost healthcare coverage for California residents who are eligible. California’s State-based Marketplace is called “Covered California.” As of January 1, 2014, California expanded Medi-Cal eligibility for low-income adults. The Medi-Cal program offers 21 different health plans for managed care. The options vary depending on which county you live in.
How is Medicare Different from Medi-Cal?
Medicare is essentially a health insurance program. The program is available to three categories of individuals: those age 65 and older (regardless of income); disabled individuals (regardless of age) and patients with end-stage renal disease, requiring dialysis. Patients with Medicare only pay a portion of their medical care costs, usually through deductibles and monthly premiums for non-hospital coverage. Medicare benefits are provided by private companies who contract with the government to do so. Since Medicare is federally-run, the requirements for coverage are basically the same everywhere.
What are the eligibility requirements for Medicare coverage?
One basic requirement for Medicare coverage is United States citizenship or permanent residency. In addition, either you or your spouse must have worked at a Medicare-covered job for at least 10 years. However, your spouse cannot receive Medicare benefits solely based on your eligibility.
Medicare Plans
Medicare benefits plans are divided into four separate “parts.” Each part is designed to provide a certain type of service. Medicare Part A provides hospital coverage, Medicare Part B provides other medical coverage. Medicare Part C includes “Medicare Advantage Plans” and Medicare Part D is prescription drug coverage. When considering which program(s) to enroll in, it would be a good idea to consult with an attorney to determine the best choice for you depending on your needs.
Medicare Part A covers in-patient care, including hospitals, nursing facilities and home health or hospice. With Medicare Part A, you can choose any hospital or facility as long as that facility accepts Medicare reimbursement.
Medicare Part B covers outpatient care and preventive medicine. Medicare Part B allows you to choose any healthcare provider that accepts Medicare. The patient is responsible for deductibles and co-payments. Essentially, Medicare Part B covers what Part A does not cover. Parts A and B are known as traditional Medicare.
Medicare Part C is provided by private companies that contract with Medicare and you must have both Parts A and B to enroll in Part C. Medicare Advantage Plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, special needs plans, and Medicare medical savings account plans. The doctors, hospitals and other healthcare providers must operate within the Medicare Advantage Plan. The purpose of Medicare Advantage Plans is to help lower medical expenses.
Medicare Part D provides prescription drug coverage. This part is usually added to Part A or Part B. Patients usually join a Medicare Prescription Drug Plan and pay a monthly premium unless the Medicare Advantage Plan they are already a part of includes prescription drug coverage.
What is a Medigap Policy?
Even with Medicare Parts A, B, C, and D, some individuals still have gaps in their overall healthcare coverage. Those individuals can enroll in the Medicare Supplement Insurance Plan, known as a “Medigap” policy. This coverage is also available through private companies. Medigap policies do not cover many types of care, such as dental, vision, hearing aids, glasses, long-term care or private-duty nursing. Most Medigap plans do not cover prescription drugs. Medigap policies are not available to those who have enrolled in one of the Medicare Advantage Plans.
Join us for a FREE seminar! If you have questions regarding California hospice care, or any other elder law issues, please contact the Schomer Law Group for a consultation, either online or by calling us at (310) 337-7696.
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