Who Pays for Hospice Care at Home? 6 Options Explained

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Hospice care is a valuable and much-needed service for people at the end of life. It is not unusual for people to wait too long to take advantage of hospice support, but hospice is not round-the-clock care, which can surprise many families. Although most insurance plans pay for hospice care, additional care is needed beyond what hospice can provide in some situations.

Jump ahead to these sections:

Not everyone has insurance, or even if they do, they may not know how insurance pays for hospice at home. Providing hospice services is expensive, and most insurance companies pay out a fixed rate based on a complicated formula that we will summarize later. Most but not all hospice companies are for-profit businesses and therefore have to consider profit margins.

Although hospice can offer families and their loved ones support and medical care, there are limits to what they can affordably provide. Most people prefer to receive hospice at home, where they are comfortable and surrounded by a familiar environment. But hospice can also occur in other settings as well, including hospitals and freestanding hospice facilities. 

What Does Hospice Care at Home Consist Of?

Hospice care at home comprises a range of services intended to manage pain and provide comfort. The team and hospice benefits consist of:

  • The hospice medical director who oversees and supervises patient care and prescribes medications.
  • The hospice nurse sees your loved one each week to assess pain and comfort level and attend to any medical needs.
  • Aides who bathe the patient and provide continence care.
  • A social worker to counsel the patient and family members.
  • A chaplain to offer spiritual support.
  • Durable medical equipment such as a hospital bed, wheelchair, or oxygen.
  • Any medical supplies and medications.

How Much Does Hospice Home Care Typically Cost?

Hospice home care reimbursement depends on several factors, including the type of care provided, the patient's insurance, the size of the community, and the level of hospice they are on.

For patients who have Medicare Part A, hospice is reimbursed at a per-day rate determined by where the patient resides and their level of hospice. These rates for the four levels of care are regulated by Medicare and paid for through the Medicare Hospice Benefit. 

The four levels of care are:

  • Routine home care which consists of pain and symptom management and emotional support for the patient and family.
  • Continuous home care is more urgent, time-limited extensive care (up to 24 hours a day) for managing symptoms.
  • General inpatient care with a contracted hospital for short term management of symptoms.
  • Inpatient respite for up to 5 days for the patient to give families a break. 

Private insurance companies usually follow the Medicare guidelines and reimburse at approximately the same daily rate. The dollar amount per day depends on the insurance plan. 

Medicaid and VA benefits reimbursement will follow state Medicare guidelines and per diem reimbursement for the four levels of care. Medicare hospice reimbursement for days 1-60 is approximately $203.40 per day. For routine home care, 61 days and over, the payment rate is $160.74, and continuous home care is at an hourly rate of $60.94 or $1,462.52 per 24-hour period.

Options to Pay for Hospice Care

Paying for hospice care is dependent on insurance. If you have private insurance, you will need to call your insurance company to review coverage. For the other options we list below, you can work with your hospice company to find out what they cover and what they don't so you don't have any surprise out-of-pocket expenses.

Hospice care is certified in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. Medical eligibility relies on the physician's assertion that the patient's life expectancy is six months or less. Still, someone can be on hospice well beyond that time frame if they continue to be medically eligible.  

1. Medicare and Medicare Advantage

For Medicare and Medicare Advantage plans to cover the full cost of approved hospice care, the company needs to be Medicare-approved, which most are. Coverage falls under the Medicare part A benefit. Once hospice begins, Medicare will not cover treatment for the terminal condition that qualified you for hospice but can treat other illnesses. 

Medicare requires that you do not go to the emergency room or hospital without hospice approval to remain eligible for the hospice benefit. Otherwise, you could jeopardize your hospice benefit. 

Medicare pays for physician and nursing services, medications, durable medical equipment, aids, counseling, and chaplains. Medicare also pays for bandages and other medical supplies.

2. Medicaid

Medicaid is a federal program administered by the US government in conjunction with the states to provide health care and other benefits to people who are low income. Medicaid covers 100% of hospice-approved services. Medicaid will reimburse hospice at about the same rate as the Medicare benefit. Not every hospice company will accept Medicaid reimbursement, so make sure you choose one that does. 

3. Veterans Benefits

For veterans who qualify and are enrolled in the Veterans Standard Medical Benefits Package or deemed eligible for Veteran’s benefits, the VA will pay 100% of all hospice costs. The VA can help you choose the hospice company, or you can decide on one yourself. 

The VA hospice program covers certain services, including medical equipment and supplies associated with the illness, on-call support throughout the day seven days a week, medications, respite care for the family when appropriate, and grief support.

How Can You Get Financial Assistance for Hospice Care at Home?

If you don’t have insurance or have other financial needs in addition to hospice, here are some options.  Charity care for people who qualify is always a possibility.

4. Hospice Help Foundation

The Hospice Help Foundation supports patients in hospice care but has financial needs in other areas. The hospice company working with your loved one applies for financial assistance on your behalf for rent, mortgage payments, utilities, and food. Hospice under any insurance plan does not pay for these necessities, which is where the Hospice Help Foundation might be able to help.

5. Charity care

Charity care is hospice care that the hospice company provides to patients who cannot qualify for Medicare, Medicaid, or private insurance and can’t cover the costs of hospice care. Most hospice companies offer charity care and may ask you to pay what you can, but you can’t be denied hospice under Medicare law because of your inability to pay. There could be non-profit hospice companies funded by United Way or other organizations that will be the go-to companies for offering charity care in your community.

Charity care funds are often provided by the hospice organization, charitable donations, grants, or other community sources. Some communities have free-standing hospice facilities for the homeless. If you need charity care, talk with your preferred hospice company about how to get it started. 

Though the hospice company is required to send statements for the care and services provided, you are under no pressure or obligation if you are unable to pay. As long as you continue to meet the Medicare guidelines for hospice care, you will continue to receive it. 

6. Resources for services not covered by hospice

Even if you have an insurance plan that pays for hospice, the financial and caregiver burden of providing care that hospice doesn’t cover can be challenging. If you consider all of the care that your loved one may need in a day, especially if they are at home, you will have to find a way to pay for that care unless your family is willing to do it.

For example, your loved one may need help eating, dressing, or toileting throughout the day. Aids are tightly scheduled and chances are your loved one will have assistance for about one hour a day, three days a week, leaving many hours of care uncovered. Hospice staff won’t be available to cover those gaps. The strain on family members to provide this care is significant. Some ideas:

  • If your loved one is a veteran, they may qualify for the VA Aid and Attendance program, which provides a monthly cash benefit that you can use to pay for caregivers and any other costs hospice doesn’t cover. The other program that might help is the VA Family Caregiver Assistance Program (PCAFC). The PCAFC program can provide a monthly stipend to caregivers and up to 30 days of respite care. 
  • With a long-term care policy in effect, you can use the daily cash benefit to cover in-home care while your loved one is in hospice.
  • Through Medicaid Home and Community Based Service (HCBS) your loved one on hospice may qualify for assistance with personal care and homemaker services. However, the first step is to be eligible for Medicaid and then apply to the HCBS program. The process could take months, so keep the time frame in mind.
  • Working with a financial planner, consider tapping into your loved one’s home equity or retirement savings to pay for additional in-home care while on hospice. There may be no better time to use your loved one’s estate to hire the help they need.

Paying for Hospice Care at Home 

Choosing to be at home while receiving hospice is what most people want—the comfort and familiarity of being at home benefits someone at the end of life. Paying for hospice care through your insurance plan should be straightforward, but remember that hospice may be unable to provide all of the care your loved one needs, so be prepared to find ways to fill those gaps. Compassionate and comprehensive care at the end of life is what everyone deserves.

Categories:

Icons sourced from FlatIcon.