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 managed 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 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% of the Medicare payment amount for inpatient respite care

Always – Pays 95% of costs

Patient pays 5% 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 for pain relief and symptom control medications

Always

Patient pays no more than $5 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: The Denver Hospice, formely 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.

National Hospice and Palliative Care Organization, www.nhpco.org

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