Paying for Hospice Care

Most hospice patients are eligible for Medicare, which covers all aspects of hospice care and services. There is no deductible for hospice services although there may be a very small co-payment for prescriptions and for respite care. In most states, Medicaid offers similar coverage.

It is important to note the Original Medicare covers hospice even if you're in a Medicare Advantage Plan. If you have supplemental insurance, such as a Medicare Advance Plan or Medicare Part B that you are paying additional premiums for, please confirm with your hospice organization before cancelling any supplemental insurance policies. While the original Medicare hospice benefit covers the costs associated with hospice care for the primary hospice diagnosis, if you or your loved one is receiving ongoing treatmenet or medications for other health problems unrelated to the primary hospice diagnosis, these costs may not be covered by the hospice provider and your supplemental policies may cover these expenses. Some Medicare Advantage plans will also cover the cost of some caregiving services in addition to those provided by Medicare-only coverage. Please check with the Advantage Plan policy holder directly to detemine if additional services are covered. For more information about hospice care and Medicare Advantage, visit https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works. 

Many health insurance plans you obtain privately, such as the kind provided by an employer, offer a hospice benefit but the extent to which they cover hospice care and services may differ from Medicare as well as from one another.

Military families have hospice coverage through Tricare.

And hospices will accept private payment, referred to as “self-pay,” which may be an option for the uninsured.

Charity care

Sometimes a person who needs hospice has no way to pay for it. Fortunately, many hospices have some mechanism by which they can provide services to people who are medically eligible but have neither insurance nor the resources to pay for their care.

Extensions, discharge, and revocation

Hospice care is given in benefit periods. You can get hospice care for two 90‑day periods followed by an unlimited number of 60‑day periods. Although medical eligibility generally relies on the physician's opinion that the patient's life expectancy is 6 months or less, neither the patient nor the physician is penalized if the patient lives longer than 6 months. The patient can be re-certified for as long as he/she continues to be medically eligible.

Sometimes with hospice care, a patient’s condition stabilizes or may even improve sufficiently so that they no longer meet medical eligibility for hospice services. At such time, the patient is “discharged” from the hospice program and their Medicare benefits revert to the coverage they had before electing hospice care.

Sometimes hospice patients may choose to pursue curative therapies such as entering a clinical study for a new medication or procedure. In order to do so, the patient must withdraw their selection of hospice care, called "revocation."

Patients who are discharged as well as any who choose to leave hospice care can re-enroll without penalty at any time they meet the medical eligibility criteria.

You can always ask

If you have any questions about costs, coverage, out-of-pocket expenses, etc., please ask! Most hospices have someone on staff who can help you understand coverage provided by whatever insurance you have. They also can help arrange for charity care, if available. 

What's Next