Private Pay
MediCal is a program of health care coverage for low income patients, even if you do not qualify for MediCare.
MediCal then assigns a health insurance carrier to cover the medical expenses of the covered persons. In Orange County, the health insurance carrier that covers MediCal beneficiaries is Cal Optima.
MediCare is a federally funded program of healthcare. To qualify for MediCare, a person must be
- 65 years or older
- have worked a job that pays for Social Security for 40 quarters of a year or more (essentially a cummulative total of 10 full years of work)
The Hospice Benefit
Major heath insurance policies have traditionally been offered as a benefit of full time employment. Usually a premium is deducted from the beneficiary's paycheck, and when visiting a doctor or the hospital, a copay or deductible is additionally paid.
However, under the 2012 Affordable Care Act, known as ObamaCare, persons who may not have health insurance coverage through their employment (either due to the workplace not offering health insurance, the employee not working full time, or the employee choosing not to sign up for the insurance offered by the employer) may choose their own heath insurance carrier and policy. In California, the health care marketplace is on the website www.CoveredCA.gov.
Insurance carriers are those of which you may be familiar include Kaiser Permanente, Blue Cross/Blue Shield, HealthNet, Anthem, and many more.
Hospice is a covered benefit under these.
MediCare
Some patients do not qualify for MediCare. This may be due to:
- not being age 65 or older
- not working 40 quarters
Some patients do not qualify for MediCal. This may be due to:
- not qualifying for MediCare (see above)
- not being below the income threshhold for assistance
Some patients may not have a health insurance carrier. This may be due to:
- Not having a job that carries health insurance as a benefit
- Not signing up for health insurance through employment
- Not signing up for health insurance through the Affordable Care Act health insurance martketplace
Patients suffering from a terminal illness that somehow do not qualify for or carry any of the above insurance options may still be admitted to a hospice program through private pay, whereupon the patient or family pays personally for any hospice charges that are incurred during their care.
Medicaid / MediCal
Since 1983, hospice care has been a covered benefit of MediCare and most major medical insurances. This means that there is no need to purchase additional "hospice" coverage, as hospice care is included within the major components of required heath coverage.