If a doctor refers you or a loved one to hospice care, you’ll likely wonder who covers the cost. This is one of the most commonly asked questions about hospice care. 

In this complete guide, we’ll explore whether insurance covers hospice, which hospice services are covered, and how long insurance will cover your hospice care. We’ll also unpack what to do if you cannot afford the inevitable out-of-pocket expenses. 

Key Takeaways 

• Hospice care is often mostly or fully covered by public insurance like Medicare and Medicaid and private medical insurance plans.

  
  

• In 2021, 1.71 million patients enrolled in Medicare’s hospice program.
  
  

• Medicare’s hospice benefit covers care for an unlimited 90-90-60 day recertification process.  

  
  

Is Hospice Care Covered By Insurance? 

The good news is that public insurance like Medicare and Medicaid and private medical insurance plans cover hospice care. However, to be able to use this coverage, you or your loved one must meet all of the eligibility requirements. 

For example, Medicare Part A patients who meet the eligibility requirements can have up to all their hospice care paid for by the government. About 85% of hospice patients can rely on Medicare for insurance coverage. Around 5% use Medicaid, around 7% use private medical insurance policies and 3% use other payment methods, including self-pay and charity.

According to a report compiled by the National Hospice and Palliative Care Organization (NHPCO), in 2021, 1.71 million patients were enrolled in Medicare’s hospice program. This means most people using hospice will have Medicare cover them.

While most Americans have some form of health insurance, in 2023, this number dropped dangerously low. The CDC reported that 7% (25.3 million) of Americans did not have health insurance because of the high costs of insurance plans or medical debt. This means in 2023, up to 25.3 million people may not have the appropriate insurance to cover hospice care. 

What Hospice Services Are Covered By Insurance?

Just because you have insurance that covers hospice care does not mean it will cover everything. You may need to prepare for some out-of-pocket expenses. 

Generally, most government-funded medical insurance programs like Medicare will provide coverage for the following hospice services: 

• An interdisciplinary team of hospice professionals: This will generally include nurses, carers, physicians, social workers, chaplains, and bereavement coordinators.
  
  

• Home medical equipment and supplies: Basic equipment like wheelchairs, hospital beds, walkers, bandages, adult diapers, latex gloves, catheters, and bedpans.  
  

• Medications related to the terminal diagnosis: This includes treatment to help manage the symptoms and is not intended to cure the diagnosis.
  
  

• Respite care: This is a temporary kind of care, giving caregivers a break from their responsibilities.
  
  

• Continuous care: This involves the process of delivering specialized treatments and care to patients in their own homes.
  
  

• Inpatient care: This is care given from within a hospice facility and not at home.
  
  

• Routine home care: This includes caregivers, equipment, and medication needed for effective care at home.
   

• Bereavement support: This service aims to prepare a family before the loss of a loved one, providing spiritual support to the patient and the grieving family.  

  
  

This list is not set in stone, as each medical insurance program has its own eligibility rules. If you have private medical insurance, you will need to contact them to find out more about what is covered for hospice care. 

Keep all your important medical insurance documents and information in one secure location, like Trustworthy. Trustworthy is a family-operating system that makes staying organized stress-free. The handy collaboration features allow you to share access to certain documents or folders if needed.  

How Can You Qualify for Insurance Coverage for Hospice Care?

Coverage for hospice care depends on whether you qualify for it. To ensure transparency and fairness, the U.S. Centers for Medicare & Medicaid Services outlines three categories doctors and other healthcare providers can use to determine whether a patient’s diagnosis or condition is appropriate for hospice care.  

These three categories are hospice eligibility requirements, disease-specific hospice eligibility criteria, and financial requirements. Your doctor will use these guidelines to determine whether you need hospice care, and insurance providers will use your doctor’s diagnosis and these eligibility criteria to decide whether you qualify for insurance coverage. 

Hospice eligibility requirements:

• Be diagnosed with a terminal condition with a prognosis of under six months based on the natural course of the disease

• The inability to carry out at least 3 of 6 activities of daily living (eating, dressing, bathing, walking, and continence) 

• A progressive weight loss (more than 10% of body weight over 4 to 6 months)

• Changes in cognitive and functional abilities 

• Decreased mental abilities 

• Frequent hospitalizations (More than three between 4 to 6 months) 

• Increased weakness and fatigue (mentally and physically) 

• Increased infections 

• An overall decline in their condition 

Some diseases have their own eligibility criteria patients need to meet. For example, patients with dementia or Alzheimer’s who experience a large decline in cognitive functions, have difficulty swallowing or have sepsis will be eligible for hospice care. 

Cancer patients who are receiving therapy but are getting worse will also qualify for hospice care. You must also meet financial requirements. Contact your insurance provider to learn more.

Store your medical documents and insurance information on Trustworthy. The family vault allows you to share this information with your family members, carers, and even your estate planning attorney.  

How Long Does Insurance Cover Hospice Care?

You should also know how long your insurance will cover hospice care to avoid a hefty bill.

For insurance to cover hospice care, you first need to qualify for it. Once you’re qualified, Medicare Part A will cover all hospice services related to a terminal illness diagnosis. If you are using Medicare, the hospice benefit covers care for an unlimited 90-90-60 day recertification process.  

Medicare will only allocate terminal patients two 90-day periods of hospice care benefits. In addition, they will also provide an unlimited number of 60-day benefit periods. 

This means that after your first 90 days in hospice, your doctor will need to re-evaluate your diagnosis and recertify you as terminally ill for another 90 days. If, after those 90 days, you are still in hospice care, your doctor will need to recertify you again, which is valid for another 60 days of benefits. These 60 periods are unlimited as long as you are terminal and your doctor recertifies you after each period.   

If you don’t use government-funded medical insurance, the terms of coverage length may vary, so you’ll need to contact your private insurance provider to find out how long they’ll pay for your hospice care. 

What Are the Costs of Hospice Care?

The costs of hospice care differ depending on whether you have insurance coverage and what level of coverage you have. 

Sylvia Gordon, a Medicare and Social Security expert from the Medicare Family, states:

“Medicare Part A is almost entirely paid for by Medicare Part A.” 

If you use the original Medicare (Part A), there may still be some co-payments. For some people, there may be a co-payment of up to $5 for outpatient medication for symptom and pain management. Other co-payments may include 5% of Medicare’s approved amount for respite care. 

Gordon also explains:

“If you get care in a nursing home, you’ll pay for room and board. Now, Medicare might pay for some or most of that, or your Medicare Advantage plan might pay for some or most of that, but you will have costs associated with hospice in a facility.”

Medicare also won’t cover the cost of a hospice care provider if it isn’t the provider your medical team set you up with. For example, you need to see your regular doctor to be covered. 

Transportation to and from medical appointments is also generally not covered. Curative treatments are not covered either, only prescriptions for pain management and to provide a better quality of life during hospice care.  

Around-the-clock caregivers are not covered either, so if you want one 24/7, you’ll have to pay for them. You’re also responsible for the cost of durable medical equipment (DME) like motorized wheelchairs, bed lifts, and sleep apnea apparatus. You and your family must be prepared to pay for these things.

If you don’t have insurance, you can expect to pay around $150 per day for home care and up to $500 per day for general inpatient care, which can quickly become costly.

What Are My Options If I Cannot Afford the Out-of-Pocket Expenses?

Hospice care can be expensive, especially if you and your loved ones need to pay multiple out-of-pocket expenses. If you battle to afford these expenses, you have some options. 

Many charities assist families with covering the costs of hospice care. Each charity has its own eligibility requirements. In fact, many hospice care facilities are nonprofits, so you may be able to find a facility that will cover these expenses for you, within reason. 

Some people also choose to take out loans if they are in a position to do so. Keep track of your loan repayments with Trustworthy’s money tab. 

Another option is to contact your hospice care provider’s financial services department and request their assistance. You may find that they can arrange a payment plan or point you in the right direction for help. 

Frequently Asked Questions (FAQs)

What is the main source of payment for hospice care? 

Hospice care is a Medicare-defined benefit, and Medicare is the main source of hospice care payment for most people. 

Which two conditions must be present for a patient to enroll in hospice?

The patient must have a terminal illness with a prognosis of six months, and they need to be frequently hospitalized. 

What diagnosis is not allowed for hospice?

Currently, a diagnosis of an adult failure to thrive or debility is not considered a primary diagnosis accepted for hospice care.  

Can you get hospice without being terminally ill?

No, to be eligible for hospice care, the patient must be diagnosed with a terminal illness.