Who pays for hospice? Medicare, Medi-Cal and health plans, and what a family pays

Money is often the question families feel they can’t ask, so they don’t. Then they spend the last weeks of a parent’s life worried about a bill that, for most people, never comes. With Medicare, hospice care costs the family nothing for the hospice care itself. This note explains who pays for what, with each program’s own rules, so you can stop worrying about it and focus on the person.

The short answer

• Medicare pays for hospice care in full under Part A. There’s no deductible.¹
• Medicare Advantage doesn’t change that. Original Medicare pays for the hospice care, even if you stay in your plan.¹
• Medi-Cal covers hospice for its members, and for people with both Medicare and Medi-Cal who live in a nursing home, Medi-Cal covers room and board.²
• The VA covers hospice for enrolled veterans who need it, with no copays.³
• Private insurance usually covers hospice too, with each plan setting its own terms.

What Medicare covers

Once someone chooses hospice, Medicare covers what the hospice team provides for the terminal illness and related conditions: the visits from the nurse, the doctor, the aide, the social worker and the chaplain; medical equipment like a hospital bed, wheelchair or oxygen; medical supplies; drugs for pain and symptoms; short inpatient stays when symptoms need them; respite care; and grief support for the family.¹

The equipment and supplies arrive through the hospice. Families don’t rent the hospital bed or buy the briefs and bandages that the plan of care calls for.

What a family pays with Medicare

Very little, and often nothing.

• Hospice care: nothing.¹
• Drugs for pain and symptoms: covered when they’re part of the plan of care. Medicare allows a copay of up to $5 a prescription, though there usually isn’t one.¹
• Inpatient respite care: up to 5% of the Medicare-approved amount.¹
• Premiums: the usual Part A and Part B premiums, for anyone who pays them.¹

What Medicare doesn’t pay for once hospice starts

Choosing hospice changes what Medicare pays for, and the booklet Medicare publishes is direct about it. Medicare won’t pay for:¹

• Treatment intended to cure the terminal illness and related conditions
• Prescription drugs for the terminal illness that aren’t for comfort
• Care from a provider the hospice team didn’t arrange
• Room and board in a nursing home or assisted living
• Emergency room visits, hospital outpatient care or an ambulance, unless the hospice team arranges them

That last one is the one that surprises families. When something happens, call the hospice first, any hour. The team can come out, change the medicines or arrange the ambulance, and Medicare covers what the team arranges. If the family goes to the emergency room on its own, they may be billed for the visit.¹

Care for other health problems

Hospice covers the terminal illness and conditions related to it. Medicare still pays for care of health problems that aren’t part of it, with the usual deductibles and coinsurance.¹ A person on hospice for heart failure who breaks a wrist can still have the wrist set.

If you have a Medicare Advantage plan

Medicare Advantage plans don’t pay for hospice. Original Medicare does, for everything related to the terminal illness, even if the person stays in their plan.¹ The plan keeps covering care for unrelated problems, and the person keeps paying its premium if they stay.¹

This matters when you choose a hospice. A plan’s network doesn’t limit the choice of hospice for Medicare hospice care.

If you have Medi-Cal

Medi-Cal covers hospice for its members, and its managed care plans must provide it when a member chooses it.² Children under 21 on Medi-Cal can keep getting treatment for their illness while on hospice, alongside comfort care.²

Room and board is where Medi-Cal makes the biggest difference. For a Medi-Cal member who lives in a nursing home, the plan pays the hospice, and the hospice pays the nursing home for room and board at no less than 95% of what the nursing home would otherwise have been paid.² For someone with both Medicare and Medi-Cal, Medicare pays for the hospice care and Medi-Cal covers the room and board.²

That room and board payment is for nursing homes. Families paying for assisted living keep paying the community while their loved one is on hospice there.

If you’re a veteran

Hospice is part of the VA’s standard medical benefits package. Every enrolled veteran is eligible when they need it, and there are no copays, whether the VA provides the care or a community hospice does under a VA contract.³

If plans change

Choosing hospice doesn’t lock in how care is paid for. A person can stop hospice at any time, and they go back to the kind of Medicare coverage they had before, including a Medicare Advantage plan if they kept it.¹ If they qualify again later, they can choose hospice again. Treatment to cure the illness is covered the usual way while they’re off hospice, with the usual deductibles and coinsurance.

Who checks all of this

You shouldn’t have to. When you call HealthView, intake checks the person’s coverage, explains what’s covered and what isn’t, and tells you in advance about anything a family would pay. If the hospice decides that some care, equipment or drugs are unrelated to the terminal illness and it won’t cover them, Medicare gives the family the right to ask for that list in writing.⁴