Hospice care doesn’t typically involve any out-of-pocket costs for families. Instead, the cost is often covered by a person’s insurance. Medicare, Medicaid, veterans benefits, and private health insurance policies all offer hospice coverage.
What is hospice care at home?
Hospice refers to end-of-life care focused on a patient’s comfort and quality of life as they approach the final stages of a serious illness, according to the National Institute on Aging. It provides pain and symptom relief for the person receiving hospice, bereavement counseling for their loved ones, and help with navigating the health care system.
Hospice services are provided in lieu of curative treatments. They're intended to provide comfort and support at the end of life. Maybe there isn’t a cure for the particular illness, or perhaps the patient has chosen to forgo certain treatments in favor of quality of life. In some cases, a person begins hospice care because their illness isn’t responding to medical treatments to cure it or slow its progression.
It’s important for a patient to discuss hospice care options with their doctor as soon as possible, as hospice can be prescribed when a person has a life expectancy of six months or less. Starting hospice sooner may provide months of comfort care and more quality time with loved ones. It also decreases the burden on family members and helps them prepare for their loved one’s death.
Read: When Is It Time To Call Hospice?
Insurance coverage to pay for in-home hospice care
The cost of hospice care at home is typically covered by common types of health insurance policies, like Medicare, Medicaid, veterans benefits, and private health insurance.
Medicare
Medicare will cover the cost of hospice care if certain criteria are met. In order to be eligible for Medicare, a person must be at least 65 years old. However, someone can qualify if they’re younger than 65 and have certain disabilities or end-stage renal disease. You can find out if your loved one qualifies for Medicare by using the Medicare eligibility tool.
Your loved one qualifies for hospice care if they have Medicare Part A and meet all of the following conditions:
- Their hospice doctor and regular doctor both certify that they’re terminally ill with a life expectancy of six months or less
- They accept palliative care instead of care to cure their illness
- They have signed a statement indicating they’re choosing hospice care over another Medicare-covered treatment for their illness
Medicare covers hospice services such as medical care, prescriptions drugs, and medical equipment. Other services, according to Medicare.gov, may include the following:
- In-home care services
- Physical, occupational, and speech therapy services
- Social services
- Nutrition counseling
- Grief counseling for your loved one and family
- Short-term inpatient care for symptom management
- Inpatient respite care, so long as it's received in a Medicare-approved facility that contracts with the hospice provider
Medicare will not cover the following:
- Treatment or medications intended to cure the patient's illness
- Care from a hospice provider that wasn’t set up by the patient's chosen hospice medical team
- Room and board at a nursing home once hospice care is initiated
Medicaid
Medicaid beneficiaries will typically pay nothing for in-home hospice care as long as certain requirements are met. However, Medicaid policies can vary from state to state. You can verify your state’s Medicaid policies by checking the appropriate state Medicaid agency website.
Medicaid hospice eligibility requirements are very similar to Medicare’s. Young people with disabilities or senior adults who meet Medicaid’s financial eligibility criteria are fully covered for end-of-life care. A doctor must certify that the patient has a life expectancy of six months or less and they must receive services from a Medicare-certified hospice provider. A hospice care plan must also be established before services can begin.
Hospice services covered by Medicaid may include the following:
- Nursing, physician, and counseling services
- Medical appliances and supplies
- Medications for pain relief and/or symptom management
- Homemaker services
- Physical and occupational therapy
For those who are eligible for both Medicare and Medicaid, Medicaid can cover the costs that Medicare doesn’t cover.
Veterans benefits
Hospice care is covered by VA health care benefits, which act as health insurance for veterans. There are no copays for hospice care.
According to the Veterans Health Administration (VHA), all veterans enrolled in VA health care are eligible for hospice coverage if they:
- Have been diagnosed with a terminal illness
- Are no longer seeking treatment other than comfort care
- Have a life expectancy of six months or less, certified by a VA physician
There are two other health care programs offered to service members and their families that can help pay for hospice care. TRICARE, and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
Private health insurance
Private health insurance plans can vary widely in terms of coverage. If your loved one has work-based or private health insurance, work with their health care provider and insurer to determine if the policy covers hospice care.
Many private health insurance plans offer a hospice benefit, but keep in mind that there may be specific eligibility requirements as well as certain limits on covered hospice expenses.
How to pay for hospice care at home without insurance
Even if a person is uninsured and can't afford to pay for hospice care out of pocket, there are many other financial assistance options available. The following resources may help ensure a loved one gets the end-of-life care they need:
- Charity care refers to free or discounted health services for people who meet a given organization’s eligibility criteria for financial assistance and are unable to pay for the services themselves. This is often provided by nonprofit hospitals, but can also be provided by hospice organizations and charitable foundations.
- Crowdfunding may be an option for those with a large support network. Platforms like GoFundMe and Fundly offer the opportunity to share your loved one’s journey and invite others to contribute to their care. While it’s not advisable to rely on crowdfunding as the primary source of financial help, it can help cover costs.
- Hospice Help Foundation offers financial assistance to patients who are currently receiving hospice care and need help paying for costs of living, such as rent, heating, and food.
No matter how you decide to pay for your loved one’s end-of-life care, you may find that you need more than just financial support. You can find support and community in AgingCare’s Caregiver Forum, where you can connect with others navigating their loved ones’ final days.
Reviewed by Todd Austin, President and COO of Home Care Pulse.
Sources:
What Are Palliative Care and Hospice Care? (https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care#hospice)
Hospice care: Comforting the terminally ill (https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050)
Hospice care (https://www.medicare.gov/coverage/hospice-care)
Medicare and Hospice Benefits (https://www.medicare.gov/Pubs/pdf/11361-Medicare-Hospice-Getting-Started.pdf)
Hospice Benefits (https://www.medicaid.gov/medicaid/benefits/hospice-benefits/index.html)
Geriatrics and Extended Care (https://www.va.gov/geriatrics/pages/Hospice_Care.asp)
Hospital Charity Care: How It Works and Why It Matters (https://www.kff.org/health-costs/issue-brief/hospital-charity-care-how-it-works-and-why-it-matters/)