When families are exploring end-of-life support for a loved one with a terminal illness, they often worry, “Can we afford hospice care?”
Fortunately, hospice care is more affordable than most expect. With coverage options available through Medicare, Medicaid, private insurance plans, and hospice financial assistance programs, families of all incomes can access high-quality care.
In this guide, we’ll break down hospice care costs, explain how the Medicare Hospice Benefit and Medicaid hospice coverage work, and explore financial assistance options. Whether you’re wondering “Does Medicare cover hospice?” or seeking guidance on how to pay for hospice care with private insurance coverage, this article will help.
Jump Ahead:
- The Basics: What Does Hospice Care Include?
- Medicare Hospice Benefit
- Medicaid Hospice Coverage
- Private Insurance Coverage for Hospice
- Veterans Benefits for Hospice Care
- Financial Assistance Programs
- Financial Planning for Hospice Care
- Financial Peace of Mind: Accessing Quality Hospice Care Without Financial Worry
The Basics: What Does Hospice Care Include?
Hospice is a specialized care model designed to support individuals facing a terminal diagnosis. Rather than focus on curative treatments, hospice care provides comfort by addressing the patient’s physical, emotional, and spiritual needs. Support is available for family members, too.
Standard hospice care includes a range of holistic services, including:
- Medical Care: Hospice doctors and nurses develop a coordinated care plan, manage pain and symptoms, and provide compassionate support.
- Personal Care Assistance: Hospice aides provide help with daily activities like bathing, dressing, and grooming.
- Medications: Medications are prescribed to relieve pain and symptoms.
- Medical Equipment and Supplies: Essential items like hospital beds, oxygen machines, and wheelchairs are provided to support care.
- Therapy Services: Physical, occupational, or speech therapy may be offered to improve a patient’s comfort.
- Emotional and Spiritual Support: Counselors, social workers, and chaplains are available to help patients and families navigate the end-of-life journey.
- Respite Care: Family caregivers can receive short-term relief through inpatient respite care.
- Bereavement Support: Hospice programs offer grief counseling in the wake of a patient’s passing.
Together, these services help patients live out their remaining time with dignity while also giving families the support they need.
Medicare Hospice Benefit
Does Medicare cover hospice? The short answer: Yes.
If your loved one is enrolled in Medicare Part A, they may qualify for the Medicare Hospice Benefit, which provides comprehensive support for individuals with terminal illnesses.
Eligibility Requirements
Your loved one may qualify for Medicare-covered hospice care if:
- They are enrolled in Medicare Part A.
- A hospice physician certifies they have a terminal illness with a life expectancy of six months or less.
- Your loved one signs a statement choosing hospice care instead of curative treatments.
- Your loved one receives care from a Medicare-approved facility.
To activate the Medicare Hospice Benefit, your loved one can receive a referral from their doctor, or they can self-refer by contacting a Medicare-certified hospice provider.
How It Works
Under Medicare, a patient can receive hospice care for two initial 90-day periods, followed by an unlimited number of 60-day periods.
At the start of the first 90-day period, a hospice physician must certify that the patient has a terminal illness with a life expectancy of six months or less. At the start of each subsequent period, a physician must recertify that the patient is still eligible for care.
What’s Covered
If your loved one qualifies for the Medicare Hospice Benefit, Medicare covers everything related to their terminal illness, including:
- Medical care from hospice doctors and nurses
- Medications to ease pain and control symptoms
- Medical equipment and supplies
- Personal care from home health aides
- Physical, occupational, or speech therapy
- Emotional and spiritual counseling
- Social work and nutritional support
- Grief and bereavement services
- Short-term inpatient care for pain or symptom management
- Respite care for up to five days at a time in an approved facility
What’s Not Covered
The Medicare Hospice Benefit does not cover:
- Curative treatments
- Medications not related to the hospice diagnosis
- Emergency care or hospital stays not arranged by the hospice team
- Room and board (except during approved short-term respite care)
If your loved one decides to stop hospice care, they can return to standard Medicare coverage.
What You Pay
While there is no deductible for hospice services, your family may be responsible for:
- Monthly Medicare Part A and Part B premiums
- Up to $5 for each outpatient prescription drug
- 5% of the Medicare-approved amount for inpatient respite care
Medicaid Hospice Coverage
Unlike Medicare, which is available primarily to people over age 65 or with certain disabilities, Medicaid is a needs-based program that serves individuals who meet specific income and asset limits. While both programs offer hospice coverage, Medicaid benefits and eligibility requirements can vary by state.
Eligibility Requirements
Your loved one may qualify for Medicaid-covered hospice care if:
- They are enrolled in Medicaid.
- A physician has certified that they have a terminal illness with a life expectancy of six months or less.
- They have chosen to receive hospice care instead of curative treatments.
- They receive care from a Medicaid-approved hospice provider.
What’s Covered
Medicaid’s hospice benefit includes many of the same services covered by Medicare. However, unlike Medicare, Medicaid often covers room and board costs in facility settings.
If your loved one qualifies for both Medicare and Medicaid (called “dual eligible”), Medicare typically pays for hospice care, while Medicaid may cover additional services like long-term care or facility costs.
State-by-State Variations
Every state administers its own Medicaid program, which means hospice coverage, services, and provider networks can vary. To determine coverage in your state, contact your state Medicaid office or speak with a local hospice provider.
How to Apply for Medicaid
In North Carolina, there are three ways to apply for Medicaid:
- Online: Your loved one can apply online by visiting ePASS NC.
- In Person: Your loved one can apply in person by contacting their local Department of Social Services. Your loved one can also print an online application and mail, email, fax, or physically drop it off at their local DSS.
- By Phone: Your loved one can call the North Carolina Medicaid Contact Center at 1-888-245-0179.
Private Insurance Coverage for Hospice
Private insurance providers also offer hospice benefits. However, coverage specifications depend on the individual plan.
Common Coverage Limitations and Requirements
Almost all major insurance providers in North Carolina, including Blue Cross NC, Aetna, UnitedHealthcare, Humana, and Cigna, cover hospice care. There are certain limitations and requirements, though.
These typically include:
- Physician Certification: Much like Medicare and Medicaid, most private insurance plans require documentation that the patient has a life expectancy of six months or less.
- Preauthorization: Some plans require prior approval or a referral from a primary care physician.
- In-Network Provider Restrictions: Coverage is often limited to the insurance company’s approved provider network.
- Limits on Care: Some private insurance plans limit the number of inpatient respite days or continuous home care hours.
- Out-of-Pocket Costs: Patients may be responsible for certain out-of-pocket costs, such as copayments and deductibles.
How to Verify Benefits and Coverage
Hospice benefits vary by insurance plan, so it’s essential to contact your loved one’s provider for details.
Consider asking the following questions:
- Does the insurance plan include hospice care benefits?
- What hospice services are covered under the plan?
- Are there any restrictions on where my loved one can receive care?
- Is preauthorization or a referral required?
- Are there limits on respite care or continuous home care?
- What are the out-of-pocket costs?
- Which hospice providers are in-network?
Knowing what to expect financially allows you to focus on your loved one’s comfort and quality of life.
Veterans Benefits for Hospice Care
The Department of Veterans Affairs (VA) provides hospice benefits to eligible veterans.
If your loved one qualifies, the VA will handle all aspects of their care, including medical support, personal assistance, pain management, and counseling. All costs are covered in full, with no copays or deductibles.
Eligibility Requirements
A veteran may qualify for hospice care through the VA if:
- They are enrolled in the VA health care system.
- A physician certifies that they have a terminal illness with a life expectancy of six months or less.
- They choose comfort-focused care rather than curative treatments.
- The hospice care is part of a VA-authorized plan.
Coordinating VA Benefits with Medicare and Medicaid
Veterans may be eligible for hospice through both the VA and Medicare or Medicaid. However, they must choose which program will cover their hospice services. A veteran cannot receive care from multiple programs at the same time for the same condition.
How to Access VA Hospice Care
If your loved one is already receiving care through the VA, speak with their primary care provider or social worker about hospice options. You can also call the VA Health Benefits Hotline at 1-877-222-VETS or use the VA facility locator to locate a nearby VA medical center.
Financial Assistance Programs
Many families worry about how to pay for hospice care. Fortunately, there are hospice financial assistance programs available to make sure your loved one receives the care they deserve.
Some options include:
- Carolina Caring Foundation connects donors to patients and families, ensuring no one goes without compassionate end-of-life care.
- Hospice Help Foundation helps cover the cost of essential supplies and services not covered by insurance.
- Capital Caring Health offers a Patient Care Fund to assist individuals without insurance or with limited coverage.
- Meals on Wheels delivers nutritious meals to homebound seniors, including those in hospice care.
- Local faith-based organizations and churches may offer financial aid, volunteer support, or in-kind donations such as food, clothing, or utility assistance.
- Area Agencies on Aging can connect families with local resources such as utility assistance and transportation services.
- Some hospice providers offer sliding scale fees based on income.
If you need help applying for financial support, reach out to your loved one’s hospice social worker. They can connect you with hospice financial assistance programs that match your family’s needs.
Financial Planning for Hospice Care
When a loved one is diagnosed with a terminal illness, it’s important to begin thinking about hospice care costs. Knowing how to pay for hospice care will help you feel more confident and prepared when the time comes.
Here are some action steps you’ll want to take during the financial planning process:
Understand Insurance Coverage
Review your loved one’s Medicare Hospice Benefit and Medicaid hospice coverage to understand what services are covered. If your loved one has private insurance, verify if it covers hospice care.
Identify Out-of-Pocket Costs
While insurance plans typically cover most hospice services, there may still be some out-of-pocket costs like copays and deductibles.
Consider Alternative Payment Sources
Depending on your family’s resources, you may need to research financial assistance programs to help cover hospice care costs.
Create a Financial Plan
Once you know the costs, create a budget that accounts for all expenses. A financial advisor can help you with this.
Talk With Your Loved Ones
Talking about money can be uncomfortable, but it’s important for the whole family to be on the same page when it comes to hospice care costs.
Here are some conversation starters:
- “Hey, I’ve been looking into what hospice care might cost, and I thought it’d be good for us to chat about how we can handle these costs together. What do you think?”
- “I think it’s important that we all understand how hospice insurance works, including any out-of-pocket expenses. Want to go over it together?”
- “I just want to make sure we’re all clear on the costs so no one gets caught off guard later. How can we make sure everyone feels good about the plan for paying for hospice care?”
Financial Peace of Mind: Accessing Quality Hospice Care Without Financial Worry
At Carolina Caring, we believe no one should delay hospice care out of fear they can’t afford it. That’s why we are deeply committed to providing high-quality end-of-life care to every patient, regardless of their ability to pay.
If you’re wondering how to pay for hospice care, our experienced team is here to help. We’ll guide you through the insurance coverage process, assist with paperwork, and connect you with hospice financial assistance programs to ease the financial burden. If you are considering hospice care for a loved one, don’t wait. Contact Carolina Caring today to speak with a compassionate team member.
