Funding Hospice Care in Nursing Homes: Who Bears the Cost?
Joel Lim
March 7, 2024
|
The intelligent digital vault for families
Trustworthy protects and optimizes important family information so you can save time, money, and enjoy peace of mind
If your loved one is facing a terminal diagnosis, it might be time to place them into hospice care. Not surprisingly, there is mental and emotional pressure that comes with realizing a loved one has limited time.
Another consideration further complicating matters is the payment for nursing home services. We’ll discuss who bears the cost of hospice care, the sources of funds for hospice care in nursing homes, and how to know if it’s right for you.
Key Takeaways
Most people in the United States have health benefits covering most of the cost of hospice care.
Hospice care costs typically range between $150 to $500 per day, but Medicare covers most aspects.
Hospice care is right if a certified doctor has confirmed the patient has less than six months to live and wants to be fully ready when the time comes.
Who Pays for Hospice Care in a Nursing Home?
The cost and available funds for hospice care won’t be a problem if you or your loved one has prior health investments in insurance, Medicare or Medicaid.
When you enroll someone for hospice care in a nursing home, several factors determine who will bear the treatment cost. However, in most cases, you won’t need to worry about the payments.
That’s because several funding programs support hospice care expenses.
Government-Backed Programs
The U.S. government initiated several health benefits catering to elderly and low-income people. The following are some of the health benefits:
Medicare
Nancy Heyerman, a certified hospice nurse at Odonata Care, explains:
“If you are a Medicare client, hospice is absolutely free to you. Medicare provides for three major areas of service. Number one: the team of professionals who are going to provide that in-home care and education. It pays for a hospital bed, wheelchair, an overbed table, and anything that’s going to help safe and comfortable care in the home. Medications are number three, and they are related to the admitting illness and medications that would be used for pain and nausea.”
While this is mostly true, Medicare omits certain things. These include room and boarding fees in a nursing home and treatment for things other than terminal illness, such as a broken bone. You may have to consider other funding sources to cover those expenses.
Medicare will not cover the cost of any curative treatment your loved ones sign up for after enrolling in hospice care.
This federal program generally covers all hospice care costs for those 65 years and older or younger people with qualifying disabilities. A patient is eligible for Medicare hospice cost coverage under the following conditions:
The individual has enrolled in Medicare Part A or Hospital Insurance.
A doctor has certified the individual to be terminally ill with a prognosis of six months or less.
The individual has resigned to comfort care and isn’t pursuing curative or life-prolonging treatment. A signed, official statement affirming their intention to not seek other treatments for their condition should back up their decision.
Medicaid
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. However, unlike Medicare, this hospice benefit is an option state plan service. This means Medicaid coverage varies by state, and it isn’t automatically available in all states across the U.S.
However, where available, Medicaid typically provides the funds for most, if not all, hospice-related expenses in nursing homes. Check if your state offers Medicaid hospice benefits and its specific eligibility requirements.
VA Programs
Your loved one may also enjoy hospice benefits courtesy of the Veteran Health Administration if they meet the eligibility requirements. This option is primarily available to veterans in the final phase of their lives. A doctor must diagnose them with having less than six months to live and having no interest in any type of treatment beyond comfort care.
Note that this option is for veterans who served in the military. All enrolled veterans who meet the clinical requirements for this benefit will get full funding support for their hospice care in nursing homes, but that’s not all. The hospice service also extends to care administration in the patient’s home or an outpatient clinic.
Private Insurance
Aside from government-backed benefits, you may also secure funds for hospice care in nursing homes through private insurance.
Several private insurance plans cover hospice costs and are a viable payment source. These private insurance companies model their hospice coverage after the Medicare benefit program.
However, the coverage may vary depending on each insurer. Understanding your coverage, including covered services and possible out-of-pocket costs is crucial. For instance, some plans may require copayments or have limitations on the duration or scope of hospice services covered.
Regardless of the coverage scope, private insurance can still help offset a significant portion of the cost.
With Trustworthy, you can manage your family’s insurance policies and find out what coverage it offers. By storing your important documents in a secure location, you can rest assured that everyone can access them when needed.
Personal Resources
If government support or private insurance cannot completely fund hospice care for your loved ones, there is another option. You can source the funds out of pocket, from friends, or through other personal channels such as:
You/Your Family
This might not sound desirable, but it may be the only option you have if the terminally ill patient isn’t eligible for any other benefits. Of course, you may also source the fund for hospice care payments from the loved one’s personal savings.
It’ll be easier if they already have measures like Trustworthy’s Family Operating System in place. This service helps terminally ill people or those near death secure and organize important family information, such as wills, insurance, taxes, and passwords, with family members and advisors.
Viatical Settlement
Similar to sourcing funding by accessing the loved one’s savings, this option enables you to raise funds for hospice care in a nursing home by selling part of their life insurance policy to a third party.
This option works when the policyholder is terminally ill and provides immediate funding support for those who will pay the cost of hospice care in nursing homes and other attached expenses.
Note that while this option provides immediate cash, it reduces the payout the policyholder’s beneficiaries will receive later. So, you should carefully consider the options before your decision.
Home Equity
Depending on your circumstances, you may also leverage your home equity through a loan or reverse mortgage to access funds for hospice care in a nursing home.
However, this option is less desirable, as it creates debt and affects your estate value, so proceed with caution. Learn more through our comprehensive estate planning guide to forward-thinking estate management practices.
Charity Funding
You can also ask for support from non-profit organizations or charitable initiatives. Several foundations provide financial assistance to individuals who need funds to cover the costs of hospice care in the United States.
How Much Does Hospice Care in Nursing Homes Cost?
According to the United States Census Bureau, approximately 39% of people have health coverage from Medicare, 19% from Medicaid, and 1% from the VA. In addition, 92.1% of Americans had health insurance in 2022.
Since most insurance covers hospice care, close to 92.1% of people in the U.S. have external funding support for hospice care. But you may find yourself among the few who aren’t eligible for any of the above benefits and need to cover the cost of hospice treatment out of pocket.
In that case, the cost of hospice care in nursing homes varies according to the facility and the quality of service they render.
According to general estimates, the average cost of hospice care in the United States ranges between $150 to $500 per day depending on the type of hospice care.
Most people will have some level of coverage for hospice care, and you may never need to pay any money out of pocket. Or if you have to, it may be a mere 5% of the total cost.
What Is Covered by Medicare?
Medicare covers most of the costs associated with hospice care through the Medicare Hospice Benefit. You only need to already have Medicare and sign up with a Medicare-approved hospice provider.
Medicare covers hospice care for those who are terminally ill with a life expectancy of six months or less.
Medicare typically covers the cost of nursing care, medical equipment, medications, and counseling related to the terminal illness.
The treatment administered under hospice care may include pain management, emotional support, and other services such as spiritual services.
Medicare will not cover any curative treatment option for the patient.
In addition, Medicare Part A covers the cost of a short-term stay in certified skilled nursing facilities. Ultimately, the coverage extent will depend on the care period and your available supplemental insurance products.
Determining If Hospice Care is Right for You
It may be time to discuss end-of-life care with your loved ones when clinical evidence has determined they have a short time left to live. The following signs indicate it’s time to sign up for hospice care:
The Individual Experiences a Rapid Health Decline
One of the first reasons to consider preparing for the worst is when your health rapidly deteriorates within a short time. This is especially true when this decline persists despite aggressive curative and management treatment.
As soon as it begins to seem like the illness is defying all treatments and there’s no hope of it ever stopping, you may want to begin preparations for the worst. Signing up for hospice care is a great way to make your last days less painful.
In addition, you should start getting your affairs in order. It’s never too early to start preparing for your funeral when you know you don’t have a long time left.
Inability to Perform Daily Tasks
Similarly, when you notice you’re beginning to lose your ability to function properly, it’s time to employ medical assistance in the form of hospice care. It isn’t ideal to wait until you completely stop being able to do things by yourself before seeking the help that you need.
You should sign up for hospice care and let others take care of you while you try to make the most of the time you have left.
That said, you should also consider a few things before opting for hospice care.
Consider Your Personal Needs
You must consider what you want before signing up for hospice care. According to a Kaiser Family Foundation poll, 70% of Americans would prefer to die at home. You might share this sentiment, in which case an at-home hospice may be the option for you.
Carefully consider your personal needs and wants before signing up for hospice care. Doing so will help you choose the option that will guarantee your maximum satisfaction.
Consider the Financial Implications
If you have coverage that caters to 100% of the hospice care cost, you shouldn’t worry about the financial implications.
If your coverage only caters to part of the cost or you have no coverage, you may want to consider how you would afford the care if you signed up for it.
You can easily structure your finances and get a great perspective on your financial capabilities using insights from Trustworthy.
Consult a Doctor
Ultimately, a professional medical practitioner is in the best position to tell you whether you should opt for hospice care. Get a doctor’s opinion and ask for their recommendation before signing up for hospice care.
Frequently Asked Questions (FAQs)
What is the main source of payment for hospice care?
Most people pay for hospice treatment through Medicare, Medicaid, or health insurance plans. However, some people may have to pay out-of-pocket.
Does Medicare pay if the patient is in hospice?
Yes, Medicare covers the cost of hospice care for a terminally ill patient.
How long can you stay in hospice on Medicare?
Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
What happens if you outlive hospice?
Patients can continue to receive hospice care if they live longer than six months, as long as a hospice doctor recertifies that they are terminally ill.
Funding Hospice Care in Nursing Homes: Who Bears the Cost?
Joel Lim
March 7, 2024
|
If your loved one is facing a terminal diagnosis, it might be time to place them into hospice care. Not surprisingly, there is mental and emotional pressure that comes with realizing a loved one has limited time.
Another consideration further complicating matters is the payment for nursing home services. We’ll discuss who bears the cost of hospice care, the sources of funds for hospice care in nursing homes, and how to know if it’s right for you.
Key Takeaways
Most people in the United States have health benefits covering most of the cost of hospice care.
Hospice care costs typically range between $150 to $500 per day, but Medicare covers most aspects.
Hospice care is right if a certified doctor has confirmed the patient has less than six months to live and wants to be fully ready when the time comes.
Who Pays for Hospice Care in a Nursing Home?
The cost and available funds for hospice care won’t be a problem if you or your loved one has prior health investments in insurance, Medicare or Medicaid.
When you enroll someone for hospice care in a nursing home, several factors determine who will bear the treatment cost. However, in most cases, you won’t need to worry about the payments.
That’s because several funding programs support hospice care expenses.
Government-Backed Programs
The U.S. government initiated several health benefits catering to elderly and low-income people. The following are some of the health benefits:
Medicare
Nancy Heyerman, a certified hospice nurse at Odonata Care, explains:
“If you are a Medicare client, hospice is absolutely free to you. Medicare provides for three major areas of service. Number one: the team of professionals who are going to provide that in-home care and education. It pays for a hospital bed, wheelchair, an overbed table, and anything that’s going to help safe and comfortable care in the home. Medications are number three, and they are related to the admitting illness and medications that would be used for pain and nausea.”
While this is mostly true, Medicare omits certain things. These include room and boarding fees in a nursing home and treatment for things other than terminal illness, such as a broken bone. You may have to consider other funding sources to cover those expenses.
Medicare will not cover the cost of any curative treatment your loved ones sign up for after enrolling in hospice care.
This federal program generally covers all hospice care costs for those 65 years and older or younger people with qualifying disabilities. A patient is eligible for Medicare hospice cost coverage under the following conditions:
The individual has enrolled in Medicare Part A or Hospital Insurance.
A doctor has certified the individual to be terminally ill with a prognosis of six months or less.
The individual has resigned to comfort care and isn’t pursuing curative or life-prolonging treatment. A signed, official statement affirming their intention to not seek other treatments for their condition should back up their decision.
Medicaid
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. However, unlike Medicare, this hospice benefit is an option state plan service. This means Medicaid coverage varies by state, and it isn’t automatically available in all states across the U.S.
However, where available, Medicaid typically provides the funds for most, if not all, hospice-related expenses in nursing homes. Check if your state offers Medicaid hospice benefits and its specific eligibility requirements.
VA Programs
Your loved one may also enjoy hospice benefits courtesy of the Veteran Health Administration if they meet the eligibility requirements. This option is primarily available to veterans in the final phase of their lives. A doctor must diagnose them with having less than six months to live and having no interest in any type of treatment beyond comfort care.
Note that this option is for veterans who served in the military. All enrolled veterans who meet the clinical requirements for this benefit will get full funding support for their hospice care in nursing homes, but that’s not all. The hospice service also extends to care administration in the patient’s home or an outpatient clinic.
Private Insurance
Aside from government-backed benefits, you may also secure funds for hospice care in nursing homes through private insurance.
Several private insurance plans cover hospice costs and are a viable payment source. These private insurance companies model their hospice coverage after the Medicare benefit program.
However, the coverage may vary depending on each insurer. Understanding your coverage, including covered services and possible out-of-pocket costs is crucial. For instance, some plans may require copayments or have limitations on the duration or scope of hospice services covered.
Regardless of the coverage scope, private insurance can still help offset a significant portion of the cost.
With Trustworthy, you can manage your family’s insurance policies and find out what coverage it offers. By storing your important documents in a secure location, you can rest assured that everyone can access them when needed.
Personal Resources
If government support or private insurance cannot completely fund hospice care for your loved ones, there is another option. You can source the funds out of pocket, from friends, or through other personal channels such as:
You/Your Family
This might not sound desirable, but it may be the only option you have if the terminally ill patient isn’t eligible for any other benefits. Of course, you may also source the fund for hospice care payments from the loved one’s personal savings.
It’ll be easier if they already have measures like Trustworthy’s Family Operating System in place. This service helps terminally ill people or those near death secure and organize important family information, such as wills, insurance, taxes, and passwords, with family members and advisors.
Viatical Settlement
Similar to sourcing funding by accessing the loved one’s savings, this option enables you to raise funds for hospice care in a nursing home by selling part of their life insurance policy to a third party.
This option works when the policyholder is terminally ill and provides immediate funding support for those who will pay the cost of hospice care in nursing homes and other attached expenses.
Note that while this option provides immediate cash, it reduces the payout the policyholder’s beneficiaries will receive later. So, you should carefully consider the options before your decision.
Home Equity
Depending on your circumstances, you may also leverage your home equity through a loan or reverse mortgage to access funds for hospice care in a nursing home.
However, this option is less desirable, as it creates debt and affects your estate value, so proceed with caution. Learn more through our comprehensive estate planning guide to forward-thinking estate management practices.
Charity Funding
You can also ask for support from non-profit organizations or charitable initiatives. Several foundations provide financial assistance to individuals who need funds to cover the costs of hospice care in the United States.
How Much Does Hospice Care in Nursing Homes Cost?
According to the United States Census Bureau, approximately 39% of people have health coverage from Medicare, 19% from Medicaid, and 1% from the VA. In addition, 92.1% of Americans had health insurance in 2022.
Since most insurance covers hospice care, close to 92.1% of people in the U.S. have external funding support for hospice care. But you may find yourself among the few who aren’t eligible for any of the above benefits and need to cover the cost of hospice treatment out of pocket.
In that case, the cost of hospice care in nursing homes varies according to the facility and the quality of service they render.
According to general estimates, the average cost of hospice care in the United States ranges between $150 to $500 per day depending on the type of hospice care.
Most people will have some level of coverage for hospice care, and you may never need to pay any money out of pocket. Or if you have to, it may be a mere 5% of the total cost.
What Is Covered by Medicare?
Medicare covers most of the costs associated with hospice care through the Medicare Hospice Benefit. You only need to already have Medicare and sign up with a Medicare-approved hospice provider.
Medicare covers hospice care for those who are terminally ill with a life expectancy of six months or less.
Medicare typically covers the cost of nursing care, medical equipment, medications, and counseling related to the terminal illness.
The treatment administered under hospice care may include pain management, emotional support, and other services such as spiritual services.
Medicare will not cover any curative treatment option for the patient.
In addition, Medicare Part A covers the cost of a short-term stay in certified skilled nursing facilities. Ultimately, the coverage extent will depend on the care period and your available supplemental insurance products.
Determining If Hospice Care is Right for You
It may be time to discuss end-of-life care with your loved ones when clinical evidence has determined they have a short time left to live. The following signs indicate it’s time to sign up for hospice care:
The Individual Experiences a Rapid Health Decline
One of the first reasons to consider preparing for the worst is when your health rapidly deteriorates within a short time. This is especially true when this decline persists despite aggressive curative and management treatment.
As soon as it begins to seem like the illness is defying all treatments and there’s no hope of it ever stopping, you may want to begin preparations for the worst. Signing up for hospice care is a great way to make your last days less painful.
In addition, you should start getting your affairs in order. It’s never too early to start preparing for your funeral when you know you don’t have a long time left.
Inability to Perform Daily Tasks
Similarly, when you notice you’re beginning to lose your ability to function properly, it’s time to employ medical assistance in the form of hospice care. It isn’t ideal to wait until you completely stop being able to do things by yourself before seeking the help that you need.
You should sign up for hospice care and let others take care of you while you try to make the most of the time you have left.
That said, you should also consider a few things before opting for hospice care.
Consider Your Personal Needs
You must consider what you want before signing up for hospice care. According to a Kaiser Family Foundation poll, 70% of Americans would prefer to die at home. You might share this sentiment, in which case an at-home hospice may be the option for you.
Carefully consider your personal needs and wants before signing up for hospice care. Doing so will help you choose the option that will guarantee your maximum satisfaction.
Consider the Financial Implications
If you have coverage that caters to 100% of the hospice care cost, you shouldn’t worry about the financial implications.
If your coverage only caters to part of the cost or you have no coverage, you may want to consider how you would afford the care if you signed up for it.
You can easily structure your finances and get a great perspective on your financial capabilities using insights from Trustworthy.
Consult a Doctor
Ultimately, a professional medical practitioner is in the best position to tell you whether you should opt for hospice care. Get a doctor’s opinion and ask for their recommendation before signing up for hospice care.
Frequently Asked Questions (FAQs)
What is the main source of payment for hospice care?
Most people pay for hospice treatment through Medicare, Medicaid, or health insurance plans. However, some people may have to pay out-of-pocket.
Does Medicare pay if the patient is in hospice?
Yes, Medicare covers the cost of hospice care for a terminally ill patient.
How long can you stay in hospice on Medicare?
Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
What happens if you outlive hospice?
Patients can continue to receive hospice care if they live longer than six months, as long as a hospice doctor recertifies that they are terminally ill.
Funding Hospice Care in Nursing Homes: Who Bears the Cost?
Joel Lim
March 7, 2024
|
The intelligent digital vault for families
Trustworthy protects and optimizes important family information so you can save time, money, and enjoy peace of mind
If your loved one is facing a terminal diagnosis, it might be time to place them into hospice care. Not surprisingly, there is mental and emotional pressure that comes with realizing a loved one has limited time.
Another consideration further complicating matters is the payment for nursing home services. We’ll discuss who bears the cost of hospice care, the sources of funds for hospice care in nursing homes, and how to know if it’s right for you.
Key Takeaways
Most people in the United States have health benefits covering most of the cost of hospice care.
Hospice care costs typically range between $150 to $500 per day, but Medicare covers most aspects.
Hospice care is right if a certified doctor has confirmed the patient has less than six months to live and wants to be fully ready when the time comes.
Who Pays for Hospice Care in a Nursing Home?
The cost and available funds for hospice care won’t be a problem if you or your loved one has prior health investments in insurance, Medicare or Medicaid.
When you enroll someone for hospice care in a nursing home, several factors determine who will bear the treatment cost. However, in most cases, you won’t need to worry about the payments.
That’s because several funding programs support hospice care expenses.
Government-Backed Programs
The U.S. government initiated several health benefits catering to elderly and low-income people. The following are some of the health benefits:
Medicare
Nancy Heyerman, a certified hospice nurse at Odonata Care, explains:
“If you are a Medicare client, hospice is absolutely free to you. Medicare provides for three major areas of service. Number one: the team of professionals who are going to provide that in-home care and education. It pays for a hospital bed, wheelchair, an overbed table, and anything that’s going to help safe and comfortable care in the home. Medications are number three, and they are related to the admitting illness and medications that would be used for pain and nausea.”
While this is mostly true, Medicare omits certain things. These include room and boarding fees in a nursing home and treatment for things other than terminal illness, such as a broken bone. You may have to consider other funding sources to cover those expenses.
Medicare will not cover the cost of any curative treatment your loved ones sign up for after enrolling in hospice care.
This federal program generally covers all hospice care costs for those 65 years and older or younger people with qualifying disabilities. A patient is eligible for Medicare hospice cost coverage under the following conditions:
The individual has enrolled in Medicare Part A or Hospital Insurance.
A doctor has certified the individual to be terminally ill with a prognosis of six months or less.
The individual has resigned to comfort care and isn’t pursuing curative or life-prolonging treatment. A signed, official statement affirming their intention to not seek other treatments for their condition should back up their decision.
Medicaid
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. However, unlike Medicare, this hospice benefit is an option state plan service. This means Medicaid coverage varies by state, and it isn’t automatically available in all states across the U.S.
However, where available, Medicaid typically provides the funds for most, if not all, hospice-related expenses in nursing homes. Check if your state offers Medicaid hospice benefits and its specific eligibility requirements.
VA Programs
Your loved one may also enjoy hospice benefits courtesy of the Veteran Health Administration if they meet the eligibility requirements. This option is primarily available to veterans in the final phase of their lives. A doctor must diagnose them with having less than six months to live and having no interest in any type of treatment beyond comfort care.
Note that this option is for veterans who served in the military. All enrolled veterans who meet the clinical requirements for this benefit will get full funding support for their hospice care in nursing homes, but that’s not all. The hospice service also extends to care administration in the patient’s home or an outpatient clinic.
Private Insurance
Aside from government-backed benefits, you may also secure funds for hospice care in nursing homes through private insurance.
Several private insurance plans cover hospice costs and are a viable payment source. These private insurance companies model their hospice coverage after the Medicare benefit program.
However, the coverage may vary depending on each insurer. Understanding your coverage, including covered services and possible out-of-pocket costs is crucial. For instance, some plans may require copayments or have limitations on the duration or scope of hospice services covered.
Regardless of the coverage scope, private insurance can still help offset a significant portion of the cost.
With Trustworthy, you can manage your family’s insurance policies and find out what coverage it offers. By storing your important documents in a secure location, you can rest assured that everyone can access them when needed.
Personal Resources
If government support or private insurance cannot completely fund hospice care for your loved ones, there is another option. You can source the funds out of pocket, from friends, or through other personal channels such as:
You/Your Family
This might not sound desirable, but it may be the only option you have if the terminally ill patient isn’t eligible for any other benefits. Of course, you may also source the fund for hospice care payments from the loved one’s personal savings.
It’ll be easier if they already have measures like Trustworthy’s Family Operating System in place. This service helps terminally ill people or those near death secure and organize important family information, such as wills, insurance, taxes, and passwords, with family members and advisors.
Viatical Settlement
Similar to sourcing funding by accessing the loved one’s savings, this option enables you to raise funds for hospice care in a nursing home by selling part of their life insurance policy to a third party.
This option works when the policyholder is terminally ill and provides immediate funding support for those who will pay the cost of hospice care in nursing homes and other attached expenses.
Note that while this option provides immediate cash, it reduces the payout the policyholder’s beneficiaries will receive later. So, you should carefully consider the options before your decision.
Home Equity
Depending on your circumstances, you may also leverage your home equity through a loan or reverse mortgage to access funds for hospice care in a nursing home.
However, this option is less desirable, as it creates debt and affects your estate value, so proceed with caution. Learn more through our comprehensive estate planning guide to forward-thinking estate management practices.
Charity Funding
You can also ask for support from non-profit organizations or charitable initiatives. Several foundations provide financial assistance to individuals who need funds to cover the costs of hospice care in the United States.
How Much Does Hospice Care in Nursing Homes Cost?
According to the United States Census Bureau, approximately 39% of people have health coverage from Medicare, 19% from Medicaid, and 1% from the VA. In addition, 92.1% of Americans had health insurance in 2022.
Since most insurance covers hospice care, close to 92.1% of people in the U.S. have external funding support for hospice care. But you may find yourself among the few who aren’t eligible for any of the above benefits and need to cover the cost of hospice treatment out of pocket.
In that case, the cost of hospice care in nursing homes varies according to the facility and the quality of service they render.
According to general estimates, the average cost of hospice care in the United States ranges between $150 to $500 per day depending on the type of hospice care.
Most people will have some level of coverage for hospice care, and you may never need to pay any money out of pocket. Or if you have to, it may be a mere 5% of the total cost.
What Is Covered by Medicare?
Medicare covers most of the costs associated with hospice care through the Medicare Hospice Benefit. You only need to already have Medicare and sign up with a Medicare-approved hospice provider.
Medicare covers hospice care for those who are terminally ill with a life expectancy of six months or less.
Medicare typically covers the cost of nursing care, medical equipment, medications, and counseling related to the terminal illness.
The treatment administered under hospice care may include pain management, emotional support, and other services such as spiritual services.
Medicare will not cover any curative treatment option for the patient.
In addition, Medicare Part A covers the cost of a short-term stay in certified skilled nursing facilities. Ultimately, the coverage extent will depend on the care period and your available supplemental insurance products.
Determining If Hospice Care is Right for You
It may be time to discuss end-of-life care with your loved ones when clinical evidence has determined they have a short time left to live. The following signs indicate it’s time to sign up for hospice care:
The Individual Experiences a Rapid Health Decline
One of the first reasons to consider preparing for the worst is when your health rapidly deteriorates within a short time. This is especially true when this decline persists despite aggressive curative and management treatment.
As soon as it begins to seem like the illness is defying all treatments and there’s no hope of it ever stopping, you may want to begin preparations for the worst. Signing up for hospice care is a great way to make your last days less painful.
In addition, you should start getting your affairs in order. It’s never too early to start preparing for your funeral when you know you don’t have a long time left.
Inability to Perform Daily Tasks
Similarly, when you notice you’re beginning to lose your ability to function properly, it’s time to employ medical assistance in the form of hospice care. It isn’t ideal to wait until you completely stop being able to do things by yourself before seeking the help that you need.
You should sign up for hospice care and let others take care of you while you try to make the most of the time you have left.
That said, you should also consider a few things before opting for hospice care.
Consider Your Personal Needs
You must consider what you want before signing up for hospice care. According to a Kaiser Family Foundation poll, 70% of Americans would prefer to die at home. You might share this sentiment, in which case an at-home hospice may be the option for you.
Carefully consider your personal needs and wants before signing up for hospice care. Doing so will help you choose the option that will guarantee your maximum satisfaction.
Consider the Financial Implications
If you have coverage that caters to 100% of the hospice care cost, you shouldn’t worry about the financial implications.
If your coverage only caters to part of the cost or you have no coverage, you may want to consider how you would afford the care if you signed up for it.
You can easily structure your finances and get a great perspective on your financial capabilities using insights from Trustworthy.
Consult a Doctor
Ultimately, a professional medical practitioner is in the best position to tell you whether you should opt for hospice care. Get a doctor’s opinion and ask for their recommendation before signing up for hospice care.
Frequently Asked Questions (FAQs)
What is the main source of payment for hospice care?
Most people pay for hospice treatment through Medicare, Medicaid, or health insurance plans. However, some people may have to pay out-of-pocket.
Does Medicare pay if the patient is in hospice?
Yes, Medicare covers the cost of hospice care for a terminally ill patient.
How long can you stay in hospice on Medicare?
Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
What happens if you outlive hospice?
Patients can continue to receive hospice care if they live longer than six months, as long as a hospice doctor recertifies that they are terminally ill.
Funding Hospice Care in Nursing Homes: Who Bears the Cost?
Joel Lim
March 7, 2024
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If your loved one is facing a terminal diagnosis, it might be time to place them into hospice care. Not surprisingly, there is mental and emotional pressure that comes with realizing a loved one has limited time.
Another consideration further complicating matters is the payment for nursing home services. We’ll discuss who bears the cost of hospice care, the sources of funds for hospice care in nursing homes, and how to know if it’s right for you.
Key Takeaways
Most people in the United States have health benefits covering most of the cost of hospice care.
Hospice care costs typically range between $150 to $500 per day, but Medicare covers most aspects.
Hospice care is right if a certified doctor has confirmed the patient has less than six months to live and wants to be fully ready when the time comes.
Who Pays for Hospice Care in a Nursing Home?
The cost and available funds for hospice care won’t be a problem if you or your loved one has prior health investments in insurance, Medicare or Medicaid.
When you enroll someone for hospice care in a nursing home, several factors determine who will bear the treatment cost. However, in most cases, you won’t need to worry about the payments.
That’s because several funding programs support hospice care expenses.
Government-Backed Programs
The U.S. government initiated several health benefits catering to elderly and low-income people. The following are some of the health benefits:
Medicare
Nancy Heyerman, a certified hospice nurse at Odonata Care, explains:
“If you are a Medicare client, hospice is absolutely free to you. Medicare provides for three major areas of service. Number one: the team of professionals who are going to provide that in-home care and education. It pays for a hospital bed, wheelchair, an overbed table, and anything that’s going to help safe and comfortable care in the home. Medications are number three, and they are related to the admitting illness and medications that would be used for pain and nausea.”
While this is mostly true, Medicare omits certain things. These include room and boarding fees in a nursing home and treatment for things other than terminal illness, such as a broken bone. You may have to consider other funding sources to cover those expenses.
Medicare will not cover the cost of any curative treatment your loved ones sign up for after enrolling in hospice care.
This federal program generally covers all hospice care costs for those 65 years and older or younger people with qualifying disabilities. A patient is eligible for Medicare hospice cost coverage under the following conditions:
The individual has enrolled in Medicare Part A or Hospital Insurance.
A doctor has certified the individual to be terminally ill with a prognosis of six months or less.
The individual has resigned to comfort care and isn’t pursuing curative or life-prolonging treatment. A signed, official statement affirming their intention to not seek other treatments for their condition should back up their decision.
Medicaid
Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. However, unlike Medicare, this hospice benefit is an option state plan service. This means Medicaid coverage varies by state, and it isn’t automatically available in all states across the U.S.
However, where available, Medicaid typically provides the funds for most, if not all, hospice-related expenses in nursing homes. Check if your state offers Medicaid hospice benefits and its specific eligibility requirements.
VA Programs
Your loved one may also enjoy hospice benefits courtesy of the Veteran Health Administration if they meet the eligibility requirements. This option is primarily available to veterans in the final phase of their lives. A doctor must diagnose them with having less than six months to live and having no interest in any type of treatment beyond comfort care.
Note that this option is for veterans who served in the military. All enrolled veterans who meet the clinical requirements for this benefit will get full funding support for their hospice care in nursing homes, but that’s not all. The hospice service also extends to care administration in the patient’s home or an outpatient clinic.
Private Insurance
Aside from government-backed benefits, you may also secure funds for hospice care in nursing homes through private insurance.
Several private insurance plans cover hospice costs and are a viable payment source. These private insurance companies model their hospice coverage after the Medicare benefit program.
However, the coverage may vary depending on each insurer. Understanding your coverage, including covered services and possible out-of-pocket costs is crucial. For instance, some plans may require copayments or have limitations on the duration or scope of hospice services covered.
Regardless of the coverage scope, private insurance can still help offset a significant portion of the cost.
With Trustworthy, you can manage your family’s insurance policies and find out what coverage it offers. By storing your important documents in a secure location, you can rest assured that everyone can access them when needed.
Personal Resources
If government support or private insurance cannot completely fund hospice care for your loved ones, there is another option. You can source the funds out of pocket, from friends, or through other personal channels such as:
You/Your Family
This might not sound desirable, but it may be the only option you have if the terminally ill patient isn’t eligible for any other benefits. Of course, you may also source the fund for hospice care payments from the loved one’s personal savings.
It’ll be easier if they already have measures like Trustworthy’s Family Operating System in place. This service helps terminally ill people or those near death secure and organize important family information, such as wills, insurance, taxes, and passwords, with family members and advisors.
Viatical Settlement
Similar to sourcing funding by accessing the loved one’s savings, this option enables you to raise funds for hospice care in a nursing home by selling part of their life insurance policy to a third party.
This option works when the policyholder is terminally ill and provides immediate funding support for those who will pay the cost of hospice care in nursing homes and other attached expenses.
Note that while this option provides immediate cash, it reduces the payout the policyholder’s beneficiaries will receive later. So, you should carefully consider the options before your decision.
Home Equity
Depending on your circumstances, you may also leverage your home equity through a loan or reverse mortgage to access funds for hospice care in a nursing home.
However, this option is less desirable, as it creates debt and affects your estate value, so proceed with caution. Learn more through our comprehensive estate planning guide to forward-thinking estate management practices.
Charity Funding
You can also ask for support from non-profit organizations or charitable initiatives. Several foundations provide financial assistance to individuals who need funds to cover the costs of hospice care in the United States.
How Much Does Hospice Care in Nursing Homes Cost?
According to the United States Census Bureau, approximately 39% of people have health coverage from Medicare, 19% from Medicaid, and 1% from the VA. In addition, 92.1% of Americans had health insurance in 2022.
Since most insurance covers hospice care, close to 92.1% of people in the U.S. have external funding support for hospice care. But you may find yourself among the few who aren’t eligible for any of the above benefits and need to cover the cost of hospice treatment out of pocket.
In that case, the cost of hospice care in nursing homes varies according to the facility and the quality of service they render.
According to general estimates, the average cost of hospice care in the United States ranges between $150 to $500 per day depending on the type of hospice care.
Most people will have some level of coverage for hospice care, and you may never need to pay any money out of pocket. Or if you have to, it may be a mere 5% of the total cost.
What Is Covered by Medicare?
Medicare covers most of the costs associated with hospice care through the Medicare Hospice Benefit. You only need to already have Medicare and sign up with a Medicare-approved hospice provider.
Medicare covers hospice care for those who are terminally ill with a life expectancy of six months or less.
Medicare typically covers the cost of nursing care, medical equipment, medications, and counseling related to the terminal illness.
The treatment administered under hospice care may include pain management, emotional support, and other services such as spiritual services.
Medicare will not cover any curative treatment option for the patient.
In addition, Medicare Part A covers the cost of a short-term stay in certified skilled nursing facilities. Ultimately, the coverage extent will depend on the care period and your available supplemental insurance products.
Determining If Hospice Care is Right for You
It may be time to discuss end-of-life care with your loved ones when clinical evidence has determined they have a short time left to live. The following signs indicate it’s time to sign up for hospice care:
The Individual Experiences a Rapid Health Decline
One of the first reasons to consider preparing for the worst is when your health rapidly deteriorates within a short time. This is especially true when this decline persists despite aggressive curative and management treatment.
As soon as it begins to seem like the illness is defying all treatments and there’s no hope of it ever stopping, you may want to begin preparations for the worst. Signing up for hospice care is a great way to make your last days less painful.
In addition, you should start getting your affairs in order. It’s never too early to start preparing for your funeral when you know you don’t have a long time left.
Inability to Perform Daily Tasks
Similarly, when you notice you’re beginning to lose your ability to function properly, it’s time to employ medical assistance in the form of hospice care. It isn’t ideal to wait until you completely stop being able to do things by yourself before seeking the help that you need.
You should sign up for hospice care and let others take care of you while you try to make the most of the time you have left.
That said, you should also consider a few things before opting for hospice care.
Consider Your Personal Needs
You must consider what you want before signing up for hospice care. According to a Kaiser Family Foundation poll, 70% of Americans would prefer to die at home. You might share this sentiment, in which case an at-home hospice may be the option for you.
Carefully consider your personal needs and wants before signing up for hospice care. Doing so will help you choose the option that will guarantee your maximum satisfaction.
Consider the Financial Implications
If you have coverage that caters to 100% of the hospice care cost, you shouldn’t worry about the financial implications.
If your coverage only caters to part of the cost or you have no coverage, you may want to consider how you would afford the care if you signed up for it.
You can easily structure your finances and get a great perspective on your financial capabilities using insights from Trustworthy.
Consult a Doctor
Ultimately, a professional medical practitioner is in the best position to tell you whether you should opt for hospice care. Get a doctor’s opinion and ask for their recommendation before signing up for hospice care.
Frequently Asked Questions (FAQs)
What is the main source of payment for hospice care?
Most people pay for hospice treatment through Medicare, Medicaid, or health insurance plans. However, some people may have to pay out-of-pocket.
Does Medicare pay if the patient is in hospice?
Yes, Medicare covers the cost of hospice care for a terminally ill patient.
How long can you stay in hospice on Medicare?
Medicare covers hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
What happens if you outlive hospice?
Patients can continue to receive hospice care if they live longer than six months, as long as a hospice doctor recertifies that they are terminally ill.
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How To Track Elderly Parents' Phone (2 Options)
Feb 1, 2023
Feb 1, 2023
Can You Collect Your Parents' Social Security When They Die?
Can You Collect Your Parents' Social Security When They Die?
Feb 1, 2023
Feb 1, 2023
How Do I Stop VA Benefits When Someone Dies (Simple Guide)
How Do I Stop VA Benefits When Someone Dies (Simple Guide)
Feb 1, 2023
Feb 1, 2023
Can You Pay Money Into A Deceased Person's Bank Account?
Can You Pay Money Into A Deceased Person's Bank Account?
Feb 1, 2023
Feb 1, 2023
Deleting A Facebook Account When Someone Dies (Step by Step)
Deleting A Facebook Account When Someone Dies (Step by Step)
Feb 1, 2023
Feb 1, 2023
Does The DMV Know When Someone Dies?
Does The DMV Know When Someone Dies?
Feb 1, 2023
Feb 1, 2023
How To Find A Deceased Person's Lawyer (5 Ways)
How To Find A Deceased Person's Lawyer (5 Ways)
Feb 1, 2023
Feb 1, 2023
How To Plan A Celebration Of Life (10 Steps With Examples)
How To Plan A Celebration Of Life (10 Steps With Examples)
Feb 1, 2023
Feb 1, 2023
How To Stop Mail Of A Deceased Person? A Simple Guide
How To Stop Mail Of A Deceased Person? A Simple Guide
Feb 1, 2023
Feb 1, 2023
How to Stop Social Security Direct Deposit After Death
How to Stop Social Security Direct Deposit After Death
Feb 1, 2023
Feb 1, 2023
How To Transfer Firearms From A Deceased Person (3 Steps)
How To Transfer Firearms From A Deceased Person (3 Steps)
Feb 1, 2023
Feb 1, 2023
How To Write An Obituary (5 Steps With Examples)
How To Write An Obituary (5 Steps With Examples)
Feb 1, 2023
Feb 1, 2023
What Happens To A Leased Vehicle When Someone Dies?
What Happens To A Leased Vehicle When Someone Dies?
Jan 31, 2023
Jan 31, 2023
Do Wills Expire? 6 Things To Know
Do Wills Expire? 6 Things To Know
Jan 31, 2023
Jan 31, 2023
How To Get Into a Deceased Person's Computer (Microsoft & Apple)
How To Get Into a Deceased Person's Computer (Microsoft & Apple)
Jan 31, 2023
Jan 31, 2023
Why Do Funeral Homes Take Fingerprints of the Deceased?
Why Do Funeral Homes Take Fingerprints of the Deceased?
Jan 31, 2023
Jan 31, 2023
What To Do If Your Deceased Parents' Home Is In Foreclosure
What To Do If Your Deceased Parents' Home Is In Foreclosure
Jan 31, 2023
Jan 31, 2023
Questions To Ask An Estate Attorney After Death (Checklist)
Questions To Ask An Estate Attorney After Death (Checklist)
Jan 31, 2023
Jan 31, 2023
What Happens If a Deceased Individual Owes Taxes?
What Happens If a Deceased Individual Owes Taxes?
Jan 31, 2023
Jan 31, 2023
Components of Estate Planning: 6 Things To Consider
Components of Estate Planning: 6 Things To Consider
Jan 22, 2023
Jan 22, 2023
What To Do If Insurance Check Is Made Out To A Deceased Person
What To Do If Insurance Check Is Made Out To A Deceased Person
Jan 8, 2023
Jan 8, 2023
What Does a Typical Estate Plan Include?
What Does a Typical Estate Plan Include?
Apr 15, 2022
Apr 15, 2022
Can I Do A Video Will? (Is It Legitimate & What To Consider)
Can I Do A Video Will? (Is It Legitimate & What To Consider)
Apr 15, 2022
Apr 15, 2022
Estate Planning For Green Card Holders (Complete Guide)
Estate Planning For Green Card Holders (Complete Guide)
Mar 2, 2022
Mar 2, 2022
What Does Your “Property” Mean?
What Does Your “Property” Mean?
Mar 2, 2022
Mar 2, 2022
What is the Uniform Trust Code? What is the Uniform Probate Code?
What is the Uniform Trust Code? What is the Uniform Probate Code?
Mar 2, 2022
Mar 2, 2022
Do You Need to Avoid Probate?
Do You Need to Avoid Probate?
Mar 2, 2022
Mar 2, 2022
How is a Trust Created?
How is a Trust Created?
Mar 2, 2022
Mar 2, 2022
What Are Advance Directives?
What Are Advance Directives?
Mar 2, 2022
Mar 2, 2022
What does a Trustee Do?
What does a Trustee Do?
Mar 2, 2022
Mar 2, 2022
What is an Estate Plan? (And why you need one)
What is an Estate Plan? (And why you need one)
Mar 2, 2022
Mar 2, 2022
What is Probate?
What is Probate?
Mar 2, 2022
Mar 2, 2022
What Is Your Domicile & Why It Matters
What Is Your Domicile & Why It Matters
Mar 2, 2022
Mar 2, 2022
What Is a Power of Attorney for Finances?
What Is a Power of Attorney for Finances?
Mar 1, 2022
Mar 1, 2022
Should your family consider an umbrella insurance policy?
Should your family consider an umbrella insurance policy?
Mar 1, 2022
Mar 1, 2022
Do I need a digital power of attorney?
Do I need a digital power of attorney?
Apr 6, 2020
Apr 6, 2020
What Exactly is a Trust?
What Exactly is a Trust?