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If your loved one has aged in place and is facing their final days due to a terminal condition, how do you plan for — and pay for — care that will keep them comfortable and ease their passing? For those on Medicare or Medicaid, the cost of end-of-life care, called hospice care, is typically completely covered. For those not on these federal insurance plans, private insurance or a health maintenance organization (HMO) are good options. Read on to learn everything you need to know about paying for in-home hospice care.

Key Takeaways

Hospice care is end-of-life comfort care that aims to preserve a patient’s dignity. It involves a collaborative plan among the patient, their family, and their care team.
Many Americans have affordable access to hospice care and multiple ways to pay. Medicare, Medicaid, private health insurance, and other options cover this essential service.
Most hospice organizations employ financial specialists. These individuals can walk your family through payment options.
Some hospice organizations have a social worker on staff. This person should be able to either complement a financial specialist’s expertise or fill that role, too.

What is hospice care?

Hospice is end-of-life comfort care — care that focuses on minimizing or preventing a terminal patient’s pain and discomfort so they can transition in dignity with as much ease as possible. This care can be provided in a community setting or in the comfort of one’s home.

According to Medicare.gov, hospice is life-affirming care that does not hasten death. It is also typically a family and health-team event — the patient, their family, and their care providers coordinate to ensure all medical and personal needs are met through the patient’s last days.^[01]

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How does my loved one obtain hospice care?

The choice to begin hospice care is not an easy one. And it should begin with a conversation between the patient and their family. Once a family is agreed, the patient’s primary care physician should be consulted. To receive hospice care, a physician must sign off that your loved one has six months or less to live.

After a physician signs off, it is wise to ask them for recommendations of hospice providers. Ask your friends and family, too. Once you have a list of providers, contact and assess each. You may need to do this on your loved one’s behalf.

Once you have selected a provider and they have agreed to admit your loved one, the provider admits your loved one and your loved one begins receiving the care they need.^[02]

Paying for in-home hospice care with Medicare and Medicaid

Individuals on Medicare, the federal health insurance plan for individuals over 65, or Medicaid, federal and state insurance for low-income individuals, can expect their hospice needs to be completely covered. Those on these insurance plans should feel no pressure to put off this end-of-life care due to financial reasons.

Guidance on receiving hospice care through Medicare

To qualify for Medicare-funded hospice care, the following must happen:

As noted above, both a hospice doctor and primary care physician must certify your loved one is terminally ill and has a life expectancy of six months or less.
Your loved one must acknowledge and accept that they will receive care to make them comfortable, not care to cure their terminal medical condition.
Your loved one must sign a document showing they’ve elected this care over other possible treatments.^[03]

Lastly, your loved one must choose to receive care from a hospice provider that is approved by Medicare.

Costs associated with Medicare-funded hospice care

Individuals on Medicare do not have out-of-pocket costs for hospice care at home. Your loved one will pay a copay of up to $5 for drugs that manage pain and other symptoms. Beyond this, your loved one may also have to pay 5% of the cost of inpatient respite care at a hospice facility (if your loved one uses that service). Additionally, if your loved one seeks care in a skilled nursing facility or other residence, the cost of room and board may not be covered.^[03]

Additional guidance

The Centers for Medicare and Medicaid Services recently updated their Medicare Hospice Benefits booklet. This publication is comprehensive and covers all the essential topics, including:

How benefits work
Eligibility requirements
The services included
How to find hospice providers

It also includes suggestions on where to find more information.

Guidance on receiving hospice care through Medicaid

Medicaid is different from Medicare in that it is about 50% funded by the federal government but is administered by states. Each state runs its Medicaid program and thus establishes its own eligibility criteria. So, those pursuing hospice coverage through Medicaid should review their state’s guidelines.

Generally, as with Medicare, to qualify for Medicaid-funded hospice care, a person must fill out an election of hospice care form, waive other curative measures, and have a physician certify that they are terminally ill and hospice care is necessary.^[04]

What Medicaid-funded hospice care covers

All the services covered under Medicare are also covered under Medicaid.

Costs associated with Medicaid-funded hospice care

Medicaid pays a hospice provider directly for all costs associated with care. A patient and their family can almost always expect there to be no out-of-pocket costs.^[05]

For more information, the Centers for Medicare and Medicaid Services maintains a general hospice benefits page.

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How to fund in-home hospice privately

There are several options for paying for hospice services beyond Medicare and Medicaid.

Private health insurance

If your parent isn’t enrolled in Medicare or Medicaid and you’re wondering how to fund hospice care privately, chances are their health insurance or health maintenance organization (HMO) offers some form of hospice coverage. Every insurer is different, and each may offer several different insurance plans. Always read a policy’s fine print to determine the level of hospice coverage it affords.

Veterans benefits

Veterans already receiving health care from the Department of Veterans Affairs (VA) are entitled to hospice care at no cost. If your parent is a veteran but is not yet receiving benefits, the first step is to apply. The U.S. Department of Veterans Affairs maintains several pages on geriatrics, extended care, and hospice services.

Social services block grants

The federal government, through the Office of Community Services, makes social service block grants available to states in order to help each state provide social services to increase citizens’ self-sufficiency.^[06]

States may choose to use these grants to fund nonmedical home care or medical home health care agencies, and these agencies may in turn provide hospice services. Every state maintains different rules, so contact your state health department or office on aging for guidance.

Charitable community organizations

There are numerous charitable organizations across the country that may pay for part or all of a person’s hospice care depending on their financial situation. To search for hospice-providing organizations near you, consider the National Hospice and Palliative Care Organization’s “Find a Care Provider” tool.

Exploring payment options with a hospice’s financial specialist

Nearly all hospice organizations have a financial specialist on staff.^[01] These staff members can help you come to a financial decision that makes sense for you and your family.

Sometimes, organizations will have a social worker on staff who is knowledgeable about financial matters and all the other aspects of hospice care, too. To connect with these kinds of professionals, start by contacting a hospice agency or agencies that seem like a good fit to you.

Next steps

If you’re trying to decide if and when hospice care may be right for your parent or if you’re curious about paying for senior care generally, Senior Care Advisors can field your questions at your convenience. Their guidance always comes at no cost to you or your family, and they are happy to meet you wherever you are in your care planning journey.

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References

Medicare.gov. How hospice works.
Hospice Foundation of America. How to access hospice care.
Medicare.gov. Hospice care.
Medicaid.gov. Hospice benefits.
Medicaid.gov. Payment for physician services under hospice.
Office of Community Services. (February 14, 2023). Social Services Block Grant Program (SSBG).

Meet the Author

Haines Eason

Haines Eason is a sandwich generation caregiver and senior copywriter at OurParents. He’s served as senior and managing editor with the company and has covered nearly all senior-relevant topics. He holds bachelor’s and master’s degrees from the University of Montana and Washington University in St. Louis, respectively.

Edited byKristin Carroll

Reviewed byTodd Austin

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Who pays for hospice care at home?