What Does Hospice Care Cost? A Financial Breakdown

Hospice care offers support for individuals facing a terminal illness, focusing on comfort and quality of life rather than curative treatments. It supports both the patient and their family. Understanding the financial aspects and common costs associated with hospice care is important for families. This article clarifies how these services are paid for and potential out-of-pocket expenses.

Understanding What Hospice Care Includes

Hospice care provides a program of support designed to manage symptoms and enhance the patient’s well-being. This care is delivered by an interdisciplinary team. Services include physicians, registered nurses, licensed practical nurses, and hospice aides for daily personal care.

The hospice benefit also includes medications for pain and symptom management. Medical equipment (e.g., hospital beds, wheelchairs, oxygen) and supplies (e.g., bandages, catheters) are provided. Therapy services, including physical, occupational, and speech therapy, are available.

Social work services offer emotional and practical assistance. Spiritual and dietary counseling are also provided.

Bereavement support is provided to the family after the patient’s passing. The program also covers short-term inpatient care for acute pain or symptom management. Respite care offers short-term inpatient stays. These services are provided as a bundled benefit by the hospice agency.

How Hospice Care is Paid For

Hospice care is largely supported by various insurance programs, making it accessible. Most patients receive coverage through government programs or private health insurance.

Medicare Hospice Benefit

Medicare Part A offers a hospice benefit for eligible individuals. To qualify, a patient must be certified as terminally ill with a prognosis of six months or less by both their attending and a hospice physician. The patient must also choose hospice care, focusing on comfort rather than curative treatments.

This benefit covers services, medications, and medical equipment provided by a Medicare-certified hospice agency. Covered services include:
Nursing care
Physician services
Medical social services
Physical and occupational therapy
Hospice aide services
Medications for pain relief and symptom control
Medical supplies and durable medical equipment

There are no deductibles or co-payments for hospice services. A small co-payment (up to $5) may apply for prescription drugs for pain and symptom management. A 5% co-payment may also be required for short-term inpatient respite care. Even if a patient is enrolled in a Medicare Advantage plan, the hospice benefit is still covered by Original Medicare.

Medicaid

Most state Medicaid programs include hospice care as a covered benefit. Similar to Medicare, Medicaid requires a physician’s certification of a terminal illness (six months or less prognosis) and the patient’s election of hospice care. Coverage details and eligibility vary by state.

Medicaid hospice coverage often mirrors Medicare services, including nursing care, medications, medical equipment, and support services. In some states, Medicaid may cover room and board costs for hospice patients in a nursing facility, often reimbursing the hospice provider at 95% of the skilled nursing facility rate.

Private Health Insurance

Many private health insurance plans offer a hospice benefit. These plans cover hospice services, including medical care, medications, and equipment. Coverage varies by policy.

Contact your insurance provider to understand benefits, deductibles, co-payments, or limitations. Some plans have network requirements. Understanding these details helps in planning costs.

Veterans Affairs (VA) Benefits

Veterans enrolled in the Veterans Health Administration (VHA) benefits package are eligible for hospice care. Eligibility requires a terminal condition (less than six months to live) and no longer seeking curative treatment. There are no co-payments for VA hospice care, whether delivered by VA facilities or contracted community providers.

The VA hospice benefit covers all care, medications, supplies, and equipment related to the veteran’s hospice diagnosis. Consult a VA social worker for more information.

Other Sources

Other sources can help cover hospice care costs. Long-term care insurance policies may include hospice benefits, though coverage varies and some policies may not cover services already covered by Medicare.

Self-pay is an option for those without other insurance, though less common. Charitable organizations and non-profit foundations may offer financial assistance, often relying on donations and grants.

Potential Patient Costs

While insurance programs cover much of hospice care, patients and families may still encounter certain costs. These expenses typically arise from services or situations not directly covered by the hospice benefit. Understanding these potential out-of-pocket costs helps families plan their finances.

Medical care unrelated to the terminal illness is generally not covered by the hospice benefit. If a patient requires treatment for a condition separate from their hospice diagnosis, their original Medicare or private insurance would typically cover these services, subject to deductibles and co-payments. For example, treatment for a broken bone or infection unrelated to the terminal illness falls outside the hospice benefit.

The hospice benefit focuses on comfort care and generally does not cover curative treatments for the terminal illness. Patients electing hospice agree to forgo aggressive treatments aimed at curing their underlying condition. If a patient pursues curative therapies for their terminal illness, they would need to disenroll from hospice, and those costs would not be covered by the hospice benefit.

Room and board expenses are a common source of confusion. If hospice care is provided in a nursing home, assisted living facility, or other long-term care setting, the hospice benefit typically does not cover room and board. The benefit covers only hospice services, not daily living costs.

Daily rates for room and board in such facilities can range from $250 to $700. However, some state Medicaid programs may cover room and board for eligible individuals in nursing facilities.

Services or supplies not deemed medically necessary by the hospice team for comfort and symptom management related to the terminal illness are generally not covered. Medicare hospice benefits have few direct patient costs, but minor co-pays for prescription drugs (up to $5) or a 5% co-payment for respite care may apply. Private insurance plans may have their own co-payments and deductibles that vary widely by policy.

Families might face indirect financial burdens. These can include lost income if a family member reduces work hours to provide care, travel expenses, and potential home modifications. While not direct medical costs, these can significantly impact a family’s financial situation.

Finding Financial Support for Hospice Care

Several resources are available to help families manage hospice care costs. Proactive communication and exploring support options can alleviate financial concerns. Hospice providers are often a primary resource.

Many hospice agencies employ financial counselors or staff who help families understand benefits and explore payment options. These professionals explain insurance coverage, outline out-of-pocket expenses, and connect families with additional resources.

Charitable organizations and foundations may offer financial assistance for end-of-life care. Some non-profit groups provide grants or aid to help cover care costs or general living expenses. These organizations often have specific eligibility criteria; inquire directly.

State and local government programs, and Area Agencies on Aging, can provide support for seniors and individuals with terminal illnesses. These programs vary by location and may offer resources that complement hospice benefits. Exploring these options can uncover additional financial relief.

For uncovered costs, a payment plan may be set up directly with the hospice provider. Many hospices work with families to arrange manageable payment schedules. Some hospice organizations offer care at no cost or a reduced rate based on ability to pay, often supported by donations and grants.

Reviewing Medicaid eligibility is another step, particularly if other primary insurance options are insufficient. Medicaid can cover hospice costs, and in some states, may contribute to room and board expenses in nursing facilities. Long-term care insurance, if applicable, might cover facility-based care not covered by the hospice benefit. Open dialogue with the hospice provider about financial concerns is encouraged.