What Hospice Costs are Covered by Medicare, Medicaid and Private Insurance?
Hospice benefits are provided on a per day (per diem) basis to the hospice provider. The hospice benefit is comprehensive, which means that all services, medications, and equipment related to the person’s hospice diagnosis are paid by the hospice. This can save patients and families a tremendous amount of money in co-pays and direct expenses because the highest co-pay a hospice can charge under Medicare or Medicaid is $5.
Specific services are described on the hospice services provided in per day coverage chart. Download a printable chart of Hospice Services Provided in Per Day Coverage [PDF]
Hospice Services Provided in Per Day Coverage
| Hospice Services Provided in Per Day Coverage | Medicare/ Medicare HMO Covered? | Medicaid Covered? | Private Plan Covered? |
|---|---|---|---|
| Routine care – symptom control; patient is comfortable; care provided through scheduled visits by hospice team (nurse, CNA, social worker, chaplain, physician) | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
| General inpatient care – short-term management for out-of-control symptoms provided in an inpatient facility | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
| Continuous care – short-term crisis care at home or in an assisted living facility with 24-hour care provided by the hospice team | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
| Respite care – 5-day maximum patient stay in a nursing facility to give the caregiver rest so he or she can continue to provide care in the home |
Always – Pays 95% of costs Patient pays 5 percent of the Medicare payment amount for inpatient respite care |
Always – Pays 95% of costs Patient pays 5 percent of the Medicare payment amount for inpatient respite care |
Depends on your plan |
| Medications – needed for the life-limiting illness |
Always Patient pays no more than $5 each for pain relief and symptom control medications |
Always Patient pays no more than $5 each for pain relief and symptom control medications |
Depends on your plan |
| Equipment and supplies – needed for the life-limiting illness and provided by hospice-approved contractors | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
| 24-hour on-call access to hospice staff support for patients and families | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
| Grief support, complementary therapies | Always – Pays 100% of costs | Always – Pays 100% of costs | Depends on your plan |
Source: Hospice of Metro Denver
What hospice costs are not covered?
Generally, Medicare, Medicaid, and private insurance will not pay for:
- Treatment, including medications, equipment and supplies, for conditions unrelated to the life-limiting illness.
- Care from physicians or other health care providers that is not set up by hospice.
- Room and board if you live at home, in a nursing home, or in a hospice residential facility.
- Emergency room visits, inpatient facility care, and ambulance transportation, unless arranged by your hospice medical team.
Free resources on a wide range of
end-of-life topics.
.gif){kind=small}
