Hospice costs are covered by several sources depending on your insurance and situation
If you're not on Medicare, hospice care can be paid for through Medicaid, private insurance, the Veterans Administration, out-of-pocket payment, or a combination of these. The payer depends on what coverage you have right now. Most hospice agencies will work with whatever insurance you hold, and many will also accept patients who have no insurance at all — though the financial responsibility then falls to you or your family.
The cost of hospice varies by location and the level of care needed, but typically includes nursing visits, medications, medical equipment, and aide services. If you're uninsured or underinsured, it's worth asking the hospice agency directly about their financial information programs or sliding-scale fees, as many have them.
Key Takeaways
- Medicaid covers hospice in all 50 states, though income and asset limits vary by state and you must meet medical criteria for hospice care.
- Private insurance plans often cover hospice, but you should call your insurer to confirm what portion they pay and whether prior authorization is required.
- Veterans and their spouses may receive hospice through the VA, and may be able to access individuals can also use VA benefits to supplement other insurance.
- Hospice agencies frequently offer financial information, payment plans, or reduced fees for uninsured patients, so ask about these options before assuming you cannot afford care.
- Out-of-pocket costs are tax-deductible in some cases, and you can ask the hospice social worker about resources specific to your situation.
Medicaid coverage for hospice
Medicaid will pay for hospice care if you meet both the financial requirements and the medical criteria. Financial requirements vary by state — some states have higher income and asset limits than others — so you'll need to contact your state Medicaid office or the hospice agency to find out whether you may have access to in your state. The hospice agency can often help you determine this over the phone.
To receive Medicaid-covered hospice, a doctor must certify that you have a terminal illness and a life expectancy of six months or less if the illness runs its normal course. Medicaid covers the full range of hospice services: nursing, aide care, medications related to your terminal condition, medical equipment, counseling, and bereavement services for your family after you die.
If you're already on Medicaid, hospice is automatically covered once your doctor makes the referral. If you're not yet on Medicaid, you can explore through your state's Medicaid office or through the hospice agency itself — many hospice social workers can help you complete the process.
Private insurance and employer plans
Most private health insurance plans, including those through an employer, cover hospice care. The amount they pay and what you pay out-of-pocket depends on your specific plan. Some plans cover hospice fully after you meet your deductible; others require a copay for each visit or service.
Before enrolling in hospice, call your insurance company and ask: What portion of hospice care does my plan cover? Do I need prior authorization from my doctor? Will I have copays or coinsurance? Is there a limit on the number of visits or length of stay? The hospice agency's billing department can also contact your insurance company on your behalf to find out what's covered.
If you're on a retiree health plan through a former employer, those plans typically cover hospice as well. Check your plan documents or call the benefits administrator to confirm.
Veterans Administration and military benefits
If you're a veteran, you may receive hospice through the VA if you're enrolled in the VA health system. VA hospice covers all services related to your terminal condition, and there are no copays for hospice care. You do not need to be on Medicare to use VA hospice.
Surviving spouses and dependents of veterans may also be may be able to access for VA hospice benefits under certain circumstances. Contact your local VA medical center or call the VA's main line at 1-800-827-1000 to ask about your may be able to access.
If you're a veteran with private insurance or Medicaid in addition to VA coverage, you can use both — the VA and your other insurance will coordinate payment.
Uninsured patients and financial information
If you have no insurance, hospice agencies will still accept you as a patient. Many agencies have financial information programs, sliding-scale fees based on income, or grants that help uninsured patients pay for care. Some agencies are nonprofit and use donations to offset costs for patients who cannot pay.
When you contact a hospice agency, ask directly: Do you have a financial information program? Can you offer a sliding scale based on my income? Are there grants or community funds available? The hospice social worker is the right person to discuss this with, and they can often connect you with other resources in your area.
Some hospice agencies will also work out a payment plan with you or your family, spreading costs over time rather than requiring full payment upfront. This is worth negotiating, especially if you're facing a large bill.
Out-of-pocket costs and tax deductions
If you pay for hospice out of pocket, some of those costs may be tax-deductible as medical expenses. You can deduct medical expenses that exceed 7.5% of your adjusted gross income in the year you pay them. Hospice services, medications, and medical equipment related to your terminal condition generally may have access to.
Keep receipts and invoices from the hospice agency. When you file your taxes, work with a tax professional or use tax software to determine whether your medical expenses meet the threshold for deduction. The hospice agency's billing department can also provide an itemized statement of what you paid, which makes it easier to track deductible expenses.
If you're concerned about affording hospice, mention this to the hospice social worker or financial counselor. They may know about local charities, religious organizations, or community programs that help pay for end-of-life care.
How to find out what your coverage is
The fastest way to learn who will pay for your hospice is to contact a hospice agency in your area and speak with their intake or financial counselor. They handle insurance verification every day and can tell you within a few minutes whether your Medicaid, private insurance, or VA benefits will cover care. You can also call your insurance company directly, but the hospice agency often gets a faster answer because they have established relationships with insurers.
If you're not sure which hospice agency to contact, ask your doctor for a referral, or call your local hospital's discharge planning department — they can recommend agencies in your area. You can also search for hospice agencies online by your city or county.
Have your insurance card or Medicaid number ready when you call. If you're a veteran, have your VA ID number available. The hospice agency will ask basic questions about your diagnosis, your doctor's name, and your insurance, and they can usually give you an answer about coverage the same day.
Frequently Asked Questions
Can a hospice agency refuse to take me if I'm uninsured?
No. Hospice agencies cannot refuse care based on inability to pay. They may ask about your financial situation to discuss payment options or financial information, but they must provide care. If an agency refuses you, contact another agency or ask your doctor or hospital for a referral to one that will accept you.
What happens if my insurance denies the hospice claim?
The hospice agency's billing department will work with your insurance company to appeal the denial. In the meantime, ask the hospice agency whether they will continue providing care while the appeal is being resolved. Most will. If the appeal is ultimately denied, the hospice agency can discuss payment options with you.
If I'm on Medicaid in one state and move to another, does hospice coverage transfer?
Medicaid coverage does not automatically transfer between states. You'll need to explore for Medicaid in your new state. However, the hospice agency can help you with this transition and may be able to continue care temporarily while your new state's Medicaid processes your process.
Can I use both Medicare and another insurance for hospice?
If you have both Medicare and another insurance (called a "Medigap" or supplemental plan), Medicare is the primary payer and the supplemental plan covers some of what Medicare doesn't. This question assumes you're not on Medicare, but if your situation changes, your hospice agency can explain how multiple insurances coordinate payment.
Does hospice cost more if I choose to stay at home versus a facility?
Hospice costs are generally the same regardless of setting — home, nursing home, or inpatient facility. What changes is what your insurance covers in each setting. Ask your insurance company or hospice agency whether your coverage differs based on where you receive care, as some plans have different copays or coverage levels for home versus facility-based hospice.