Does Private Insurance Pay for Hospice Care?

If you have private health insurance from your employer or retirement plan, you may already be aware of your basic benefits such as prescription and health care coverage. It becomes a bit more murky when you are applying it to specific procedures, which includes things like hospice and palliative care. You may be paying a smaller amount toward your premium for basic coverage or choose to pay more to cover the widest amount of options possible. While private health insurance benefits and expenses vary greatly, most plans include hospice care coverage.

‍

Here’s what you want to see when choosing or reviewing your private insurance options for hospice care.

‍

What Hospice Services Do Private Insurances Cover?

In the U.S., it is expected that private health insurance companies write their own policies, and as a result, coverage varies between companies. That said, many insurers use the federal Medicare hospice benefit program as a benchmark for covering nearly 100 percent of hospice costs.

‍

They can cover the same options, such as:

‍

• Doctors overseeing your hospice plan
• Nurses to implement symptom management
• Medical equipment and supplies related to the terminal diagnosis
• Homemakers, home health aides, and social workers
• Spiritual counseling and bereavement counseling
• Prescription medications for pain and symptom management
• Physical therapy, occupational therapy, and speech-language pathology therapy services
• Short-term in-patient care if it’s needed to manage symptoms
• Short-term respite care for up to five days to give caregivers time to rest

‍

How Can I Find Out What My Private Health Insurance Covers?

To learn what hospice benefits you have, you may want to contact your health insurance provider directly. Their website and/or customer support team can walk you through your benefits, specific services covered, and any expected out-of-pocket costs. Given how health care works in the U.S.,  it is also wise to review your in-network versus out-of-network benefits and choose a hospice provider that meets your budget and takes your insurance.

‍

Who Uses Private Health Insurance to Cover Hospice Costs?

Many individuals use Medicare to pay for hospice services. However, anyone can be faced with a terminal illness and require hospice care, regardless of their age.  As a result, not everyone who needs hospice care is eligible for Medicare. That’s why some patients, especially those younger than 65, may turn to private insurance to pay for hospice and other end-of-life services.  

‍

Of course, hospice benefit eligibility criteria still applies. Like Medicare, in order to qualify for hospice, a doctor must certify that you have a terminal illness with fewer than six months to live. You might also need to stop seeking curative treatment for your terminal illness.

‍

Will My Private Long-Term Care Insurance Cover Any Hospice Costs?

Then there’s long-term care insurance, which is a specific kind of  private insurance designed to make everything from in-home care to nursing homes more affordable. Depending on your policy, you may be able to use it in conjunction with your private health insurance, Medicare, or other benefits to help lower your total cost.

‍

One such way you can use LTC is for room and board at a nursing facility. Most private health insurance companies will not cover room and board at a nursing home facility. If you meet the eligibility criteria for both types of insurance, you could use LTC to pay for nursing home room and board and use your private health insurance to pay for actual hospice services.

‍

Using Private Insurance to Pay For Hospice

Having time while on hospice is important, and knowing what will pay for your care can help. If you are able to pay for long-term care insurance as well as private insurance, you can find a variety of options available for hospice.

‍

References

1. “Hospice Care.” Medicare.gov, www.medicare.gov/coverage/hospice-care.