Does insurance cover hospice?

Which insurance covers hospice?

Almost every kind of health coverage pays for hospice. What differs is how much you may pay and which hospices you can use.

General information, not a benefits determination. We check your benefits and tell you your costs before care starts.

Is hospice covered by private insurance?

Usually, yes. California law requires every group contract from a health care service plan licensed in California, except specialized plans such as dental-only plans, to include hospice care that is at least equal to the hospice care Medicare provides (Health and Safety Code section 1368.2). This rule does not apply to members who choose hospice under Medicare instead.

Individual and small-group plans, including those sold through Covered California, must cover California's essential health benefits, and that list includes hospice care (Health and Safety Code section 1367.005 and Insurance Code section 10112.27).

These sections cover only the plans and policies they name: group contracts from health care service plans, and individual and small-group plans and policies. If your coverage is something else, for example a large employer's insurance policy or a plan regulated outside California, ask the plan directly what hospice benefit it has.

What does hospice cost with insurance?

With Medicare or Medi-Cal, most people have no bill for hospice care itself. With a private plan, it depends on the plan. It may apply a deductible, a copay or coinsurance, or limit you to hospices in its network. It may also require approval before care starts or before a short inpatient stay.

Health plans usually do not pay for room and board where you live. At home that is the household's rent and food. In a nursing home it is the bed and daily care, paid by the resident or family, long-term care insurance, or Medi-Cal for eligible residents. See how much does hospice cost? and hospice in a nursing home.

Medicare Advantage, Medi-Cal and both

If you have a Medicare Advantage plan, Original Medicare pays the hospice once you elect hospice. Unless you leave the plan, you stay enrolled and can still get through it any benefits that are not the hospice's responsibility, such as its extra benefits (42 CFR 422.320). See Medicare Advantage.

If you have both Medicare and Medi-Cal, Medicare pays for hospice care first. Medi-Cal can pay nursing home room and board for eligible residents. If you have private insurance and Medi-Cal, the hospice bills the private insurance before Medi-Cal (DHCS All Plan Letter 25-008).

Does long-term care insurance cover hospice?

Long-term care insurance usually helps pay for daily care, not for the hospice itself, which Medicare or another health plan pays. Depending on the policy, it may help pay for a nursing home or assisted living fee, or for hired caregivers at home, while the person is on hospice. Policies differ a great deal.

Ask the insurer whether the policy pays while the person is on hospice, whether there is a waiting period before benefits start, and whether care by family members or by an agency counts.

Does the VA cover hospice?

Yes. Hospice is part of the VA's Standard Medical Benefits Package, so veterans enrolled in VA health care can get it when they meet the clinical need. The VA says there are no copays for hospice care, whether the VA provides it or an organization with a VA contract does. When the VA pays, it provides hospice itself or purchases it from a community hospice; the VA social worker can tell you how to arrange it. A veteran who also has Medicare can choose Medicare to pay for hospice instead. See hospice care for veterans.

What to ask your insurer about hospice

• Does my plan cover hospice, and is the benefit at least equal to Medicare's?
• Is there a deductible, copay or coinsurance for hospice care, medicines or inpatient stays?
• Do I have to use a hospice in your network? Which hospices are in network near me?
• Do you need to approve hospice before it starts, or before a short inpatient stay?
• Does the benefit include all four levels of care: routine home care, continuous home care, general inpatient care and respite care?
• Is there a limit on days or dollars?
• If I also have Medicare or Medi-Cal, which pays first?

Common questions about insurance and hospice

Related guides

Paying for care, does Medicare cover hospice?, how much does hospice cost?, and Medi-Cal and hospice.