Does Insurance Cover Hospice?

If the patient has Medicare Part A and meets hospice eligibility requirements, then the government will pay as much as 100% of the cost of hospice care. In such a case, there is no deductible and no copayment for the patient. Even if a hospice patient is enrolled in a Medicare Advantage plan, hospice benefits are covered by original Medicare.

About 90 percent of hospice patients rely on Medicare and Medicaid to cover their care, and the rest turn to other financing sources, which for most people means private insurance. Most private health plans align with Medicare in their requirements for hospice: A patient must be diagnosed with a terminal illness (indicating a life expectancy of six months or less) and must choose not to receive curative treatment.

Most people enroll in health insurance plans through an employer or retirement program, while others purchase plans through a private or public exchange. Individuals who do not have Medicare but have coverage from private insurance should contact their health plan directly for specific details on hospice care, including what the patient’s plan will cover and which out-of-pocket costs the patient and their family may be responsible for.

Medicaid provides coverage, but it varies by state.

Hospice Services Covered by Private Insurance

Once you’ve met the qualifications outlined by your insurance provider, you should confirm what services will be covered by the plan, and which—if any—expenses you are responsible for.

Here are some hospice services commonly covered by private health insurance plans modeled after the Medicare Hospice Benefit:

• An interdisciplinary team of hospice professionals
• Home medical equipment and supplies
• Medications related to the terminal diagnosis
• Respite care
• Continuous care
• Inpatient care
• Routine home care
• Bereavement support