Hospice Payment Sources Outside Medicare

If you or a family member needs hospice but Medicare is not available, payment comes from Medicaid, private insurance, out-of-pocket funds, or a combination of these. The source depends on what coverage you have and your income level. Most people use more than one payer — for example, Medicaid covers the hospice services while you or family members cover medications or supplies not included in the hospice benefit.

Hospice is expensive. A typical day of hospice care costs between $150 and $300, though this varies by location and the level of care needed. If you have no insurance and limited savings, you still have options: some hospice providers offer sliding-scale fees based on income, and some nonprofits cover costs for uninsured patients. The key is to ask the hospice provider directly what they can do before you assume you cannot afford it.

Key Takeaways

  • Medicaid covers hospice for people who meet income and asset limits, and the rules are less strict for hospice than for other Medicaid services.
  • Private insurance plans, including employer coverage and individual policies, often cover hospice but require you to check your plan documents or call your insurer to confirm.
  • Veterans and their spouses may be covered through the VA, which runs its own hospice programs or contracts with private providers.
  • Hospice providers themselves sometimes offer reduced fees or free care based on income, so asking about financial hardship programs is a necessary first step.
  • Out-of-pocket costs can be reduced by understanding what the hospice benefit includes and what family members or community resources can cover instead.

Medicaid as a Hospice Payer

Medicaid covers hospice in all 50 states, and the income and asset rules for hospice are often more lenient than for other Medicaid services. You do not have to be on Medicaid already — you can explore for it specifically to cover hospice. The income limit varies by state; some states use 133% of the federal poverty level, others use 200% or higher. For 2024, the federal poverty level for a single person is roughly $14,600 per year, so a state at 200% would allow income up to about $29,200.

Asset limits also vary by state. Some states count only liquid assets (cash, bank accounts) and exclude your home and one vehicle. Others have higher or lower thresholds. Because these rules change and differ widely, you need to contact your state Medicaid office or a local Area Agency on Aging to learn what your state allows. Many people who would not may have access to for Medicaid for other reasons do may have access to for hospice-only Medicaid.

Once Medicaid approves you, it covers the full cost of hospice services — nursing, aides, social work, chaplaincy, medications related to the terminal illness, and equipment. You typically pay nothing out of pocket for these services. Some states require a small copay per visit, but most do not.

Private Insurance and Employer Plans

Most private health insurance plans, including employer group plans and individual policies purchased on the marketplace, cover hospice. The coverage is usually similar to Medicare's: the insurer pays the hospice provider a daily rate, and you pay your regular copay or coinsurance if your plan has one. Some plans cover hospice with no copay at all.

The catch is that you must check your specific plan. Call your insurance company or read your plan documents to confirm hospice is covered, what the copay or coinsurance is, and whether there are any restrictions (such as requiring the hospice provider to be in-network). Some plans require the hospice provider to be certified by a specific accrediting body; most hospice providers meet these standards, but it is worth confirming.

If you have coverage through your employer and you are still working or recently retired, your plan likely covers hospice. If you are unemployed or self-employed and buying individual coverage, hospice is usually included, but read your policy or call to be sure. Plans sold on the marketplace (healthcare.gov or your state exchange) must cover hospice as part of the essential health benefits.

VA Coverage for Veterans and Spouses

The Department of Veterans Affairs covers hospice for veterans who meet service requirements and for some surviving spouses. The VA runs its own hospice programs at some medical centers and contracts with private hospice providers in other areas. Coverage is free for the veteran; there is no copay or coinsurance.

To use VA hospice, you must be enrolled in the VA health system. If you are not already enrolled, you can explore through your local VA Medical Center or online at va.gov. The VA will evaluate whether you meet may be able to access based on your service history and current health status. Surviving spouses of veterans may also be covered under certain circumstances; contact your local VA to ask whether your spouse qualifies.

If the VA does not have a hospice program near you, they will contract with a private provider and pay them directly. You still pay nothing out of pocket. This is one of the most comprehensive hospice benefits available, so if you are a veteran or the spouse of one, exploring VA coverage should be your first step.

Hospice Provider Financial Hardship Programs

Many hospice providers, especially nonprofit organizations, have financial hardship or charity care programs. These programs reduce or eliminate your out-of-pocket cost if you have no insurance and limited income. The provider will ask you to fill out a financial form showing your income and assets, and they will determine what you can afford to pay — which may be nothing.

To find out whether a hospice provider offers this, ask directly during your first conversation with them. Say: "We do not have insurance. Do you have a program for patients who cannot pay?" Most providers will say yes. Some will ask you to pay what you can; others will cover the full cost. The availability and generosity of these programs varies, so you may need to contact several providers to find one that fits your situation.

Nonprofit hospices are more likely to have robust charity care programs than for-profit ones, though many for-profit providers also offer financial information. If you are working with a hospital or health system, ask whether they have a hospice program and what their financial information policy is.

Out-of-Pocket Costs and What They Cover

Even with insurance or Medicaid, you may have out-of-pocket costs. These typically include medications not related to the terminal illness, medical equipment not covered by the hospice benefit, and supplies like incontinence products or wound care supplies beyond what the hospice provides. Family members often pay for comfort items — special food, air purifiers, or extra blankets — that are not medical necessities.

Understanding what your hospice benefit includes helps you budget for what you will pay yourself. Ask the hospice provider for a written list of what they cover and what they do not. Most hospice benefits include nursing visits, aide services, medications for the terminal illness, medical equipment (hospital bed, wheelchair, oxygen), and spiritual care. They usually do not include non-terminal medications, experimental treatments, or 24-hour in-home care (though they can arrange short-term respite care).

Some costs can be offset by community resources. Local nonprofits, religious organizations, and disease-specific foundations sometimes provide grants or donations to cover hospice-related expenses. Your hospice social worker can help you find these resources. Asking family and friends to help with specific costs — such as a meal delivery service or help with household tasks — can also reduce the financial burden on the patient and primary caregiver.

How to Start the Conversation About Payment

The time to ask about payment is before you choose a hospice provider, not after services begin. When you are comparing providers, ask each one: "What insurance do you accept? If we have no insurance, what are our options?" Get the answer in writing if possible. Ask whether they accept Medicaid, and if so, whether you can explore for Medicaid through them or whether you need to explore separately through your state.

If you are already on a payer (Medicaid, private insurance, VA), contact that payer before you contact hospice. Ask them what hospice services are covered, what you will pay out of pocket, and whether there are any restrictions on which providers you can use. Then use that information when you call hospice providers to make sure there are no surprises.

Be honest about your financial situation. Hospice providers and social workers have seen every scenario and are not there to judge. If you say upfront that you have limited funds, they can steer you toward the right payment option or financial information program from the start, rather than discovering the problem later.

Frequently Asked Questions

Can I get hospice if I have no insurance and no money?

Yes. Many hospice providers, especially nonprofits, have charity care programs that cover uninsured patients with no income. You will need to fill out a financial form, but if you may have access to, the provider covers the cost. Some providers ask you to pay what you can afford, which may be very little or nothing. Contact local hospice providers directly to ask about their financial information policy.

If I am on Medicaid for something else, does it cover hospice?

Medicaid covers hospice in all states, but you need to make sure your state Medicaid plan includes it and that you meet the hospice-specific requirements. Most people who are already on Medicaid can add hospice coverage without reapplying. Contact your state Medicaid office or your Medicaid case manager to confirm. If you are not on Medicaid yet, you can explore specifically for hospice-only Medicaid, which often has higher income limits than regular Medicaid.

What if my private insurance denies hospice coverage?

Ask the insurance company in writing why they denied it and request the specific policy language they are using. Hospice providers often appeal denials on your behalf, so tell your hospice provider about the denial and ask them to file an appeal. If the appeal fails, ask whether the hospice provider has a financial information program or whether you can switch to Medicaid or another payer. Do not assume the denial is final without an appeal.

Does hospice cost more if I pay out of pocket than if I have insurance?

No. Hospice providers charge the same daily rate regardless of payer. If you have no insurance, you may pay the full rate, but you are not charged more than an insured patient. Many providers will reduce the rate or waive it entirely if you demonstrate financial hardship. Always ask about financial information before assuming you must pay the full amount.

Can I switch hospice providers if I cannot afford the first one?

Yes. You can change hospice providers at any time, and there is no penalty for doing so. If your first provider's financial information program does not work for you, contact another provider and ask about their options. Some providers are more generous with charity care than others, so it is worth shopping around if cost is a concern.