Hospice care allows seniors to receive supportive care in the comfort of their own home surrounded by friends and family. Typically, hospice care at home costs nothing to patients who are covered by common health insurance policies, making hospice services an accessible option for your loved one. As you plan for end-of-life care for a loved one, understand what home hospice services cost, which services are covered by insurance, and what you should expect to pay out of pocket.
Hospice care at home: Coverage and options
Hospice care focuses on caring instead of curing, with hospice staff trained in pain and symptom management to help maximize your loved one’s comfort. Receiving hospice care at home allows terminally ill patients to remain close to loved ones in a familiar environment during a difficult time.
In-home hospice care costs vary depending on the level of care provided, which is determined by the hospice physician with input from the patient’s regular physician. Health insurance plans differ, but many policies cover either all or a portion of in-home hospice services. In many cases, hospice patients aren’t responsible for any out-of-pocket costs.
The following home hospice care options are typically covered by insurance providers.
- Routine home hospice care offers regular care visits at a patient’s home. This option is the most common type of hospice service.
- Continuous home hospice care takes place at a patient’s residence and provides up to 24/7 support to help a patient through a crisis.
While home hospice services may be your loved one’s first choice, keeping them at home may not be possible if their needs are too complex. An in-home assessment from a hospice provider will help them understand a senior’s condition so they can recommend an appropriate approach. Some seniors may have to move to a nursing home or skilled care facility to receive the care they need and maximize their quality of life.
Who pays for in-home hospice care costs?
Most health insurance plans pay for home hospice care. What you and your family can expect to pay will depend on the level of care needed, whether services are provided at home or in a facility, current insurance coverage, income, and more.
Insurers set certain eligibility criteria for their beneficiaries to receive hospice care.
- Medicare beneficiaries with Medicare Part A — either through Original Medicare or a Medicare Advantage Plan — will typically pay nothing for hospice care. Medicare fully covers home hospice costs for patients who are terminally ill and who have committed to hospice care over curative treatment. There may be a co-pay of up to $5 for each prescription drug used to manage symptoms, but the hospice provider must explain in advance which drugs aren’t covered. According to research conducted by the National Hospice and Palliative Care Organization, most hospice patients have their costs covered by Medicare.
- Medicaid beneficiaries will pay nothing for in-home hospice care as long as certain requirements are met. Similar to Medicare, patients must have a terminal prognosis and elect to receive only comfort care. Medicaid eligibility requirements and policies vary by state, so be sure to check with the appropriate State Medicaid Agency to verify that hospice care is covered.
- VA health care benefits cover home hospice costs with no additional copays for eligible veterans who meet the clinical needs for hospice.
- Private health insurance policies vary, but many cover at least a portion of hospice costs. To find out what hospice services are covered by a health insurance policy, reach out to the insurer.
Many hospice providers are grant-funded or operate as non-profit organizations. If your loved one is uninsured or cannot afford the care they need, contact local hospice providers to ask if they offer services at reduced rates or charity care (at no cost). It’s uncommon for a patient or their family to pay for hospice care entirely out of pocket.
What hospice services are covered?
Hospice costs typically include the following:
- Physician and nursing services
- Medical equipment and prescription drugs that work to address pain and symptom management
- Medical supplies
- Physical and occupational therapies
- Grief counseling for surviving family members, supporting them for up to 13 months through the challenging one-year anniversary of their loved one’s passing
What hospice services aren’t typically covered?
Hospice care is only available to patients who have committed to receiving comfort care over curative care. Once starting hospice, insurance likely will no longer cover the cost of preventative treatments and curative prescription drugs. And unless they’re ordered directly by the hospice team, emergency care services including ambulance fees aren’t covered.
Finding support during a difficult time
If your loved one receives hospice care at home, hiring an in-home aide to be a part of their care team may ease your personal caregiver burden. Home health aides can help with personal care and daily tasks so you can spend quality time with your loved one instead of worrying about when they need their next dose of medication. Having another senior care partner in the home as you navigate your loved one’s end-of-life care can offer much-needed support during a difficult time.
AgingCare’s Caregiver Forum is a safe space where family caregivers can connect with one another and bond over shared experiences. With thousands of questions and helpful answers to browse and engage with, caregivers can find a support network like no other.
Sources:
National Hospice and Palliative Care Organization: 2020 Hospice Facts and Figures (https://www.nhpco.org/hospice-facts-figures/)
Hospice Levels of Care (https://www.medicare.gov/care-compare/resources/hospice/levels-of-care)
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2022 (https://www.cms.gov/files/document/r11542CP.pdf)
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