PATIENT & FAMILY GUIDE

Understanding how care is covered.

For many patients, home health and hospice care are covered by Medicare or other health insurance, with little or no out-of-pocket cost for covered services.

The coverage rules are different for each type of care. Here's what you should know and how Aspen can help you understand what applies to your situation.

What Medicare covers

Medicare provides separate benefits for eligible home health and hospice patients. While the services and eligibility requirements differ, both benefits are designed to make important care accessible without placing the full financial burden on patients and families.

HOME HEALTH

$0 for covered home health services.

Under Original Medicare, eligible patients pay nothing for covered home health services.

This can include skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and qualifying home health aide services.

Certain medical equipment may involve separate costs. Under Original Medicare, patients generally pay 20% of the Medicare-approved amount for covered durable medical equipment after meeting the applicable Part B deductible.

Learn about Aspen Home Health Medicare's home health coverage information

HOSPICE

$0 for covered hospice care.

Under the Medicare hospice benefit, eligible patients generally pay nothing for covered hospice services related to their terminal illness and related conditions.

Covered care can include nursing, physician services, medications for symptom management, medical equipment, supplies, counseling, and other services included in the hospice plan of care.

Certain outpatient medications may involve copayments of up to $5 per prescription, and inpatient respite care may involve limited cost-sharing. Room and board in a residential facility generally isn't covered by the hospice benefit.

Learn about Aspen Hospice Medicare's hospice coverage information

What if I have a different insurance plan?

Many patients receive care through Medicare Advantage, Medicaid, or private health insurance.

These plans may cover home health or hospice services, but their requirements can differ. Depending on your plan, coverage may involve provider networks, prior authorization, specific eligibility requirements, or different cost-sharing arrangements.

For patients enrolled in Medicare Advantage, Medicare-covered hospice care is generally paid through Original Medicare, even when the patient remains enrolled in the Medicare Advantage plan.

Your local Aspen team can help you understand the next steps for confirming your benefits and whether the appropriate services are available through your plan.

When might there be additional costs?

For many eligible patients, covered home health and hospice services come with little or no direct cost. However, some items or services may fall outside the applicable benefit.

Examples include certain medical equipment under the home health benefit, limited hospice medication or respite-care copayments, services unrelated to the hospice diagnosis, and care or assistance not covered by a patient's insurance.

Before care begins, your Aspen team can help explain the services being arranged and identify any known coverage questions or potential patient responsibilities.

The goal is to help you understand what to expect without unnecessary surprises.

We're here to help you understand your coverage.

Insurance can be complicated, but you don't need to figure everything out on your own.

When speaking with your local Aspen team, a few questions can help clarify what applies to your situation:

Is the home health or hospice care I need covered by my insurance?
Are there any out-of-pocket expenses I should expect?
Does my plan require authorization or have network restrictions?
Who can help if I have questions about coverage or a bill?

Our local teams can help you understand the next steps and connect you with the appropriate resources.

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