As our loved one begins their end-of-life journey, caregivers may find it overwhelming to figure out how to pay for hospice care. The first step is understanding the available coverage for hospice under Medicare and Medicaid. Knowing the federal and state resources available to you will help lighten your load during this stressful time and help your family prepare financially.
This guide will cover Medicare and Medicaid hospice coverage, the eligibility requirements, and what out-of-pocket costs you may incur. Equipped with this important hospice benefit knowledge, you can ensure your loved one receives the high-quality care they deserve, allowing them to live out their days comfortably.
Medicare-approved hospice programs cover all costs directly related to pain relief and symptoms associated with a terminal illness. Medicare will cover the following costs for up to six months. However, after six months, patients can continue to receive Medicare-covered hospice care if the hospice doctor recertifies that the individual is still terminally ill.1 Coverage includes the following:
Did You Know: Patients can still see their regular physician if the physician is elected to aid in supervising the patient's hospice care.
It's important to know the benefits Medicare will not cover once you initiate hospice care. Coverage does not include the following:
Did You Know: Keeping in close contact with your loved one's hospice care team helps avoid unexpected out-of-pocket costs. When in doubt, speak with a team member to confirm what services are covered.
To qualify for Medicare hospice coverage, the individual needs to meet the following requirements:
While Medicare fully covers a large portion of hospice services, including treatment from the hospice care team, occupational, physical, and speech services, and medical equipment, the patient may incur costs for some services:
Did You Know: If a prescription is not covered under the patient's Medicare hospice plan, ask a hospice care team member to inquire if the medication is covered under Medicare Part D.
Medicaid is a partnership between the federal government and individual states. Medicaid-covered hospice care is optional and varies by state. States that do provide Medicaid-funded hospice benefits must follow federal regulations for basic coverage. This coverage is similar to Medicare and includes providing:
As Medicaid is state-run, it's essential to confirm if your state offers Medicaid-covered hospice care and what benefits are included within the coverage.
The requirements to qualify for Medicaid hospice care will vary from state to state. If the patient qualifies for Medicaid, they must follow the requirements for Medicaid's hospice benefits.3 Common requirements include:
The time when someone can begin using Medicaid coverage for hospice services is based on the individual state's determination of life expectancy. For example, Indiana defines a terminal illness as having a life expectancy of six months or less, while Colorado's required prognosis is nine months or less.4
Older adults who qualify for Medicaid-covered hospice care are exempt from copayments, coinsurance, and deductibles. Hospice care, including room and board, is covered under Medicaid whether the individual lives at home or resides in a nursing home, assisted living facility, or rehabilitation center.5 Medicare doesn't offer hospice coverage for room and board, so this is an excellent benefit.
If an individual doesn't qualify for Medicare or Medicaid, or the coverage they have simply isn't adequate, there are other ways to pay for hospice care.
|Option||Pros||Cons||Things to Consider|
|Private Health Insurance (HMO, PPO, POS)||Can be employer-sponsored or via individual coverage.||Potential for limited choice of in-network providers and hospitals; out of network providers may not be covered.||Coverage of hospice care and services will vary by plan.|
|Veteran Healthcare||Zero copays; wide range of veteran healthcare and living options.||Must meet eligibility requirements, including enlistment, duty, and type of discharge.||Must be enrolled in the VA's healthcare system to receive benefits.|
|Out of Pocket||Avoids debt if the individual does not qualify for full Medicare or Medicaid coverage.||Personal savings can be drained quickly due to high costs.||Before paying out of pocket, verify your state's Medicare and Medicaid eligibility requirements.|
|Reverse Mortgage||No monthly mortgage payment; the individual retains ownership of their home.||Must be 62 years or older to be eligible; costly due to multiple upfront and ongoing fees.||The loan amount depends on the individual's age, interest rates, and the home's value.|
|Grants & Donations||Some hospice organizations may offer care at no cost or at a reduced rate based on the individual's ability to pay.6||Not all hospice care facilities have the means to provide low- or no-cost service.||Research local non-profit and community-funded hospice care.7|
Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt
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See local housing communities:
Medicare.gov. (2021). How hospice works.
Center for Medicare Advocacy. (2021). Hospice.
Medicaid.gov. (2021). Hospice Benefits.
KFF. (2018). Medicaid Benefits: Hospice Care
CMS. (2021). An Overview of the Medicaid Hospice Benefit.
American Cancer Society. (2021). How and Where Is Hospice Care Provided and How Is It Paid For?
Hospice Foundation. (2021). Paying for Hospice Care.