What Insurance Covers for Hospice Care and What It Doesn't

Insurance coverage for hospice depends on the type of insurance you have and whether the hospice is certified

Most health insurance plans — including Medicare, Medicaid, and many private plans — cover hospice care when a doctor certifies that a patient has six months or less to live. However, the coverage varies by plan and by state. Car insurance does not cover hospice care under any circumstances, since hospice is a health service, not a vehicle-related expense.

If you arrived here from a car insurance question, you may be looking for information about health insurance instead. This article covers health insurance and hospice. If you need to understand what your car insurance covers, that is a separate category of coverage entirely.

Key Takeaways

• Medicare covers hospice care at no cost to the patient once a doctor certifies a terminal diagnosis with six months or less to live.
• Medicaid covers hospice in all states, though the specific services and payment amounts vary by state program.
• Private health insurance plans cover hospice differently depending on the plan; you must check your policy documents or call your insurer to know what is covered.
• Hospice must be certified by Medicare or your state to be covered by most insurance; uncertified hospice providers are rarely covered.
• Out-of-pocket costs for hospice can include copays, coinsurance, or the full cost if the provider is not in-network or not certified.

How Medicare covers hospice care

Medicare Part A covers hospice care once a doctor has documented that the patient has a terminal illness with a prognosis of six months or less. The patient must also sign a statement choosing hospice care instead of curative treatment. When these conditions are met, Medicare covers the full cost of hospice services — there is no copay, coinsurance, or deductible.

The hospice agency must be Medicare-certified for this coverage to explore. You can verify whether a hospice is certified by calling Medicare at 1-800-MEDICARE or by searching the Medicare provider directory online. If the hospice is not certified, Medicare will not pay, and you will be responsible for the full cost.

Medicare covers hospice services including nursing care, doctor visits, medications related to the terminal condition, medical equipment, counseling, and respite care (temporary relief for the primary caregiver). It does not cover room and board if the patient is in a nursing home or assisted living facility — only the hospice services themselves.

Medicaid coverage for hospice in your state

Medicaid covers hospice in all 50 states, but the details differ by state. Some states cover hospice services more broadly than others, and payment rates to hospice agencies vary. To find out what your state's Medicaid program covers, contact your state Medicaid office directly or visit the Medicaid website for your state.

Like Medicare, Medicaid requires that the hospice be certified by the state or by Medicare. The patient must also have a doctor's certification of a terminal diagnosis. If you are on Medicaid and need hospice, start by calling your state Medicaid program to learn which hospices are covered and what the enrollment process is.

Private health insurance and hospice coverage

Private health insurance plans vary widely in how they cover hospice. Some plans cover hospice services fully once a terminal diagnosis is certified. Others require copays or coinsurance. Some plans limit the number of days or the types of services covered. You must review your own policy or call your insurance company to know what you are covered for.

When you call your insurer, ask whether hospice is covered, whether the hospice must be in-network, whether there are copays or coinsurance, and whether there are limits on the length of stay or types of services. Write down the name of the person you spoke with and the date, in case you need to refer back to the conversation later.

If your plan does not cover hospice or covers it only partially, you may still be able to use a hospice agency and pay out of pocket, or you may be able to switch to Medicare or Medicaid if you meet the requirements.

What "certified" means and why it matters

A certified hospice is one that has met federal or state standards for staffing, training, record-keeping, and patient care. Certification is not optional — it is the requirement that insurance companies use to decide whether to pay. If a hospice is not certified, insurance will not cover it, and you will pay the full cost yourself.

To verify that a hospice is certified, ask the hospice directly or check with your state's health department. Medicare-certified hospices can be found in the Medicare provider directory. If you are unsure whether a hospice is certified, do not assume it is — ask before enrolling.

Out-of-pocket costs you may still owe

Even when insurance covers hospice, you may have out-of-pocket costs. If your plan has copays or coinsurance, you will owe those amounts. If you use an out-of-network hospice, your plan may cover less or nothing. If the hospice is not certified, insurance will not pay at all.

Some hospice agencies offer financial counseling to help families understand costs and explore options for covering them. If cost is a barrier, ask the hospice about this service. Some agencies also have funds to help patients who cannot afford care.

What happens if you do not have insurance

If you do not have health insurance, you may still be able to receive hospice care. Some hospice agencies provide care regardless of ability to pay, though this varies by agency and location. Contact hospices in your area directly to ask about their policies for uninsured patients.

You may also be able to enroll in Medicare or Medicaid if you meet the requirements. If you are over 65, you are may be able to access for Medicare. If your income is low enough, you may be may be able to access for Medicaid. A hospice social worker can help you explore these options.

Frequently Asked Questions

Does car insurance cover hospice care?

No. Car insurance covers vehicle-related expenses only. Hospice care is a health service and is covered by health insurance — Medicare, Medicaid, or private health plans — not by auto insurance.

What if my doctor says I have six months to live but my insurance denies hospice?

Contact your insurance company's appeals department and ask them to review the denial. Provide your doctor's written certification of the terminal diagnosis. If the denial stands, ask your doctor or hospice social worker whether you meet the requirements for Medicare or Medicaid instead.

Can I use any hospice I want, or does it have to be in-network?

This depends on your plan. Some plans cover any certified hospice. Others require you to use an in-network provider. Call your insurance company to ask whether the hospice you are considering is in-network before you enroll.

Does insurance cover hospice for children?

Yes, if the child has a terminal diagnosis certified by a doctor. Medicare, Medicaid, and most private plans cover pediatric hospice. The process is the same as for adults — the doctor must certify the diagnosis, and the hospice must be certified.

What if I change my mind and want to stop hospice and go back to treatment?

You can stop hospice at any time and return to curative treatment. Your insurance will switch back to covering regular medical care. However, if you later want to return to hospice, your doctor will need to re-certify the terminal diagnosis.