How to Pay for Hospice Care

When you or a loved one are in need of hospice care, it is important to know how to choose a provider, when to start the service, and how the care will be paid for. There are generally four types of payors for hospice care: Medicare, Medicaid, Private Third Party Insurance, and Private Pay.

The red, white and blue Medicare card pays for hospice care whether the care is provided at home, in a nursing facility, adult group home, or family members' home. By presenting your Medicare card to your hospice provider at the time of starting services (hospice admission), the hospice will bill Medicare for all care and services that are provided to you.

According to the most recent data from the National Hospice and Palliative Care Organization (NHPCO), almost 85% of hospice care in the USA is paid for by Medicare. Hospice care is completely paid for by the red, white and blue card. If you have questions about what is provided for Medicare recipients by hospice, click here for more information.

Medicaid is a state managed healthcare insurance program that provides benefits for impoverished children and adults. Because Medicaid is a state program it is up to each state to determine if a benefit for hospice is provided. In the event you or a loved one are in need of hospice care, it is best to contact either your physician or your hospice of choice. These healthcare providers will be able to assist you in determining if Medicaid pays for hospice in your state. Annually, about 5% of all hospice care provided is paid for by Medicaid.

If you have major medical insurance, you may have benefits for hospice care. More than 7% of hospice care provided each year is paid for by private third party insurers. It is important to know and understand your benefits before beginning hospice care.

If you or a loved one have been diagnosed with a terminal illness or a chronic illness has reached its final stages, you should contact your insurance provider to confirm benefits available for hospice. If you have difficulty with that, you may contact a local hospice provider. The hospice provider can talk with your insurance company with your permission to determine whether or not you have benefits for hospice and what limitations, co-pays, or deductibles may be required.

Typically, hospice benefits provided by private third party insurers are the same as those provided by Medicare. These insurance programs generally have a 6 month benefit limit that cannot be extended. So, the timing of the referral to hospice is important from both a health and financial standpoint. My best advice here is to refer to hospice sooner rather than later. If the hospice benefit provided by your insurance exhausts before the time of death, continuation of necessary care can begin on a private pay basis.

For those who are not insured by Medicare, Medicaid or private third party insurance there is always an option to pay for hospice services privately. Annually, 1% of hospice care provided is paid for on a private basis. Hospice providers will typically make arrangements with patients and families to provide care under this financial arrangement. The cost of care will vary from one organization to another. If you are in need of hospice care for yourself or a loved one and do not have insurance, contact a local hospice agency and ask about private pay arrangements.