Does health insurance cover hospice care? In almost every case, yes. Medicare Part A pays for hospice with virtually no out-of-pocket cost and is the most common payer. Medicaid covers it in nearly every state. TRICARE and VA benefits cover it for military families and veterans. Most private plans include a hospice benefit, though the details vary. What differs across these plans is who qualifies, what counts as a covered service, and how much (if anything) the patient pays.
Medicare Hospice Coverage
Medicare Part A offers the most extensive hospice benefit of any U.S. insurer. To qualify, a patient must be enrolled in Part A and certified as terminally ill by two physicians, meaning a life expectancy of six months or less if the illness runs its normal course. The patient must also choose comfort-focused care over curative treatment for the terminal illness and sign a written election statement.1Medicare.gov. Hospice Care Patients do not need to be homebound, have an advance directive, or hold a do-not-resuscitate order.2Center for Medicare Advocacy. Medicare Hospice Benefit
Once enrolled, Medicare covers the full range of services tied to the terminal diagnosis: physician and nursing care, medications for pain and symptom management, medical equipment and supplies, hospice aide and homemaker services, physical, occupational, and speech therapy, medical social services, dietary and spiritual counseling, and grief counseling for the patient and family before and after death.3Centers for Medicare & Medicaid Services. Hospice Short-term inpatient care for symptom crises and respite care for caregivers are also included.1Medicare.gov. Hospice Care
What You’ll Pay
For most hospice services from a Medicare-approved provider, the patient pays nothing. There are two small exceptions: a copayment of up to $5 per prescription for outpatient drugs used for pain and symptom control, and a copayment of 5% of the Medicare-approved amount for inpatient respite care.1Medicare.gov. Hospice Care The respite copayment cannot exceed the inpatient hospital deductible for the year.3Centers for Medicare & Medicaid Services. Hospice A Medigap policy can reduce or eliminate even these costs. Most Medigap plans (A, B, C, D, F, G, M, and N) cover 100% of the Part A hospice copayment; Plan K covers 50% and Plan L covers 75%.4Medicare.gov. Compare Plan Benefits
What Medicare Won’t Cover
Once a patient elects hospice, Medicare stops paying for any treatment intended to cure the terminal illness or related conditions. It does not cover room and board in a home, nursing home, or hospice facility, aside from narrow exceptions for short-term inpatient stays arranged by the hospice team. Care from outside providers that the hospice team didn’t arrange isn’t covered, and neither are emergency room visits, hospital stays, or ambulance transport related to the terminal illness unless the hospice team set them up.1Medicare.gov. Hospice Care Always contact the hospice team before seeking outside care, or you may be responsible for the full cost.5Medicare.gov. Medicare Hospice Benefits Treatment for health problems unrelated to the terminal illness continues to be covered under normal Medicare rules, subject to usual deductibles and coinsurance.
How Long Coverage Lasts
There’s no fixed limit on Medicare hospice coverage. The benefit runs in periods: two initial 90-day periods, then an unlimited number of 60-day periods, each requiring recertification by a hospice physician that the patient remains terminally ill.1Medicare.gov. Hospice Care Starting with the third benefit period, recertification must include a face-to-face encounter between the patient and a hospice physician or nurse practitioner.3Centers for Medicare & Medicaid Services. Hospice A patient can revoke hospice at any time, return to standard Medicare, and re-elect hospice later if still eligible. Patients may also change hospice providers once during each benefit period.2Center for Medicare Advocacy. Medicare Hospice Benefit
Medicare Advantage: Coverage Reverts to Original Medicare
A common point of confusion. Medicare Advantage (Part C) plans do not cover hospice. Under a rule dating back to the Balanced Budget Act of 1997, patients who elect hospice revert to Original Medicare (Part A) for that benefit. They can keep their Medicare Advantage plan for services unrelated to the terminal illness.6Hospice News. In or Out: The Hospice Medicare Advantage Conundrum The practical effect for the patient is minor: hospice is still covered, just billed through Part A.
Medicaid Hospice Coverage
Hospice is technically an optional benefit under Medicaid, meaning each state decides whether to include it, but nearly every state does. A 2018 KFF survey found 46 states reported covering hospice, with no state reporting that it declined to cover the benefit (five states did not report data).7KFF. Hospice Care Medicaid hospice services must be provided by agencies that meet Medicare conditions of participation, and coverage must last at least 210 days.2Center for Medicare Advocacy. Medicare Hospice Benefit
Medicaid generally requires patients to forgo curative treatment for the terminal illness when electing hospice, with one key exception: children under age 21 on Medicaid can receive both curative treatment and hospice care at the same time, a right established by Section 2302 of the Affordable Care Act in 2010.8Medicaid.gov. Concurrent Care for Children
For patients eligible for both Medicare and Medicaid, Medicare Part A covers the hospice services and Medicaid covers room and board for patients living in a nursing facility. Medicaid pays the hospice provider a per diem rate equal to 95% of the skilled nursing facility rate, and the hospice passes that payment through to the facility.9Medicaid.gov. Hospice Payments This matters because Medicare on its own does not cover room and board.
TRICARE Hospice Coverage
TRICARE covers hospice care in the United States and its territories for service members, retirees, and their families. The benefit mirrors Medicare’s structure: a physician certification of a life expectancy of six months or less, the same benefit period framework of two 90-day periods followed by unlimited 60-day periods, and the same four levels of care. Covered services include physician care, nursing, counseling, medical equipment and supplies, medications, therapies, home health aide services, and personal comfort items.10TRICARE. Hospice Care
TRICARE requires pre-authorization for each benefit period and uses Medicare-certified hospices under participation agreements with the Defense Health Agency.11TRICARE Reimbursement Manual. Hospice Reimbursement As with Medicaid, beneficiaries under age 21 can receive both hospice and curative care at the same time. TRICARE does not cover hospice received overseas.10TRICARE. Hospice Care
VA Hospice Benefits
The Department of Veterans Affairs provides hospice as part of its standard medical benefits for all enrolled veterans. Eligibility requires a VA physician to determine that the veteran has a terminal condition with a life expectancy of six months or less and that treatment goals are focused on comfort rather than cure.12Department of Veterans Affairs. Palliative and Hospice Care Fact Sheet There are no copays, whether the care is delivered directly by the VA or through a community hospice under VA contract.13Department of Veterans Affairs. Hospice Care
Veterans who are also eligible for Medicare or Medicaid can choose the VA as their payer for hospice services.12Department of Veterans Affairs. Palliative and Hospice Care Fact Sheet If a veteran instead elects the Medicare hospice benefit, CMS has clarified that this does not prevent the veteran from also receiving VA services outside the Medicare hospice plan of care, such as home-based primary care for unrelated conditions.14LeadingAge. CMS Clarifies How Veterans Access VA Benefits While on Medicare Hospice
Private Health Insurance
Most major private insurers cover hospice, but the specifics vary widely by plan. Unlike Medicare’s standardized benefit, private plans may impose different network requirements, copays, and prior authorization rules.15Tillery Compassionate Care. How to Pay for Hospice Care The Affordable Care Act does not list hospice among the ten required essential health benefit categories for marketplace and small-group plans, so there is no federal mandate requiring private plans to include it.16Centers for Medicare & Medicaid Services. Essential Health Benefits In practice, many plans do cover hospice. Review your specific policy or call your insurer to confirm what is included.
Long-term care insurance can sometimes help. Some policies include hospice coverage, though because Medicare typically already covers hospice, it is often not a standard feature. When these policies do cover hospice, benefits are usually triggered by the inability to perform at least two activities of daily living or by cognitive impairment, and there’s often a waiting period of 30 to 180 days before payments begin.17Texas Department of Insurance. Long-Term Care Insurance
If You Don’t Have Coverage
Patients without insurance or with limited coverage still have paths to hospice. Many providers operate on a mission-based model and accept patients regardless of ability to pay. Johns Hopkins Medicine notes that many hospice programs are “provided regardless of the person’s ability to pay.”18Johns Hopkins Medicine. Paying for Home Health and Hospice Care Some providers offer sliding-scale fees based on income, and organizations such as the Hospice Help Foundation, along with individual provider charity funds, help cover costs for uninsured patients.19Carolina Caring. Hospice Cost
Hospice social workers can help families identify and apply for financial assistance, including Medicaid enrollment, community resources like Meals on Wheels, faith-based organizations, and Area Agencies on Aging that offer transportation and utility help.19Carolina Caring. Hospice Cost Self-pay is also an option. The most practical first step for anyone uncertain about coverage is to contact a local hospice directly and ask.