Many people assume hospice care is readily available for anyone facing a serious illness, but eligibility rules are often stricter than expected. To qualify, patients must meet specific medical criteria and choose comfort-focused care over curative treatments. Yet, despite Medicare covering over 90% of hospice patients, families still face unexpected costs—with out-of-pocket expenses ranging from $500 to $10,000+, depending on care needs and location.
With 1.7 million Americans entering hospice each year, understanding who qualifies and what costs to expect is crucial. Let’s break down hospice eligibility requirements, potential expenses, and financial options like viatical settlements to help ease the burden of end-of-life care.
Who Qualifies for Hospice Care?
To receive hospice care, a hospice doctor and hospice medical director must certify that a patient has a serious illness with a life expectancy of six months or less if the disease follows its normal course. The patient must also choose palliative care over curative measures, meaning the focus shifts from aggressive treatments to symptom management and comfort.
Common Conditions That Qualify for Hospice
Hospice is available for individuals with various life-limiting conditions, including:
- Cancer patients, including those with metastatic cancer
- Neurological diseases such as Huntington’s disease, multiple sclerosis, and neurological conditions affecting mobility or cognition
- Cardiopulmonary disease, including heart failure and congestive heart failure
- Chronic obstructive pulmonary disease (COPD) and advanced liver disease
- Hepatic encephalopathy and other organ failure conditions
Medical Criteria for Hospice Eligibility
Hospice providers follow disease-specific guidelines to assess eligibility. Common indicators include:
- A palliative performance scale score of 70% or lower
- Consistent weight loss and declining nutritional status
- Frequent emergency room visits or hospitalizations
- A decline in daily living activities, such as dressing, eating, or walking
What Services Does Hospice Care Provide?
Hospice care provides medical, emotional, and spiritual support, but many families are shocked by the hidden costs they still have to cover. While Medicare pays for 85-100% of hospice services, families often face out-of-pocket expenses ranging from $500 to over $10,000, depending on the level of care needed.
Around 30% of hospice patients require additional services—like 24/7 in-home care, prescription drugs, or specialized treatments—that insurance may not fully cover.
Without proper planning, these costs can become a financial burden. Below, we’ll break down what hospice actually covers, what it doesn’t, and how families can prepare for the expenses ahead.
Hospice Services
- Pain and Symptom Management – Hospice focuses on symptom management for conditions like cancer, congestive heart failure, chronic obstructive pulmonary disease, and neurological diseases. Medications and therapies are provided to ease discomfort and improve daily living.
- Personalized Care Plans – Each hospice team creates a care plan tailored to the patient’s needs, including medical treatment, counseling, and spiritual support.
- Emotional and Spiritual Support – Hospice aides, social workers, and chaplains help patients and their loved ones cope with emotional and spiritual challenges.
- Respite Care for Families – Hospice providers offer temporary relief for caregivers, allowing family members to rest while the hospice care team takes over.
- 24/7 Availability – Hospice care is available at all times, ensuring that patients receive support whenever needed.
Hospice services can be provided in private homes, assisted living facilities, nursing homes, or hospitals, depending on the patient’s preferences and medical needs. These services are covered under Medicare Part A, Medicaid, and most private insurance companies, making hospice an accessible option for many.
Covering Hospice Costs with a Viatical Settlement
While hospice care is covered by Medicare Part A, Medicaid, and most private insurance companies, some expenses – such as uncovered treatments, home modifications, or additional caregiving support may not be fully covered. For families facing financial strain, a viatical settlement can provide immediate funds to help ease the burden of end-of-life care.
While hospice care is covered by Medicare Part A, Medicaid, and most private insurance plans, families are often left with significant out-of-pocket expenses. Costs can vary based on the level of care, location, and whether a patient has comprehensive insurance.
Breakdown of Hospice Costs With and Without Medicare
- Basic Hospice Care (Home or Facility-Based)
- With Medicare/Insurance: Typically covered at 85-100%, but families may still pay for uncovered medications, additional nursing care, and equipment.
- Without Medicare/Insurance: Costs range from $5,000 to $15,000 per month, depending on location and services needed.
- Inpatient Hospice Care (Hospice Center or Hospital-Based)
- With Medicare/Insurance: Coverage varies, but daily copays for inpatient stays can be $5 to $200 per day.
- Without Medicare/Insurance: Can cost $500 to $1,500 per day, adding up to $15,000 to $45,000 per month.
- Uncovered Costs Families May Face
- 24/7 in-home nursing: $200–$500 per day
- Non-covered prescription drugs: $50–$1,000 per month
- Medical equipment (hospital beds, oxygen, etc.): $500–$5,000 if not fully covered
- Home modifications (ramps, bathrooms, etc.): $3,000–$10,000+
- Additional caregiver support: $25–$50 per hour for private caregivers
For families facing unexpected medical and caregiving costs, these expenses can quickly drain savings or create financial stress.
A Realistic Case: Hospice Costs and How a Viatical Settlement Helps
A patient diagnosed with late-stage lung cancer needs full-time hospice care at home. The family expects Medicare to cover most of the costs, but soon realizes several expenses aren’t included:
- 24/7 nursing care for pain management: $12,000/month
- Non-covered medications: $700/month
- Home modifications (wheelchair ramp, hospital bed rental, etc.): $4,500 one-time cost
- Additional caregiver support for bathing, meals, etc.: $3,000/month
- Total estimated out-of-pocket costs over 4 months: $60,800
How a Viatical Settlement Covers the Gap
The patient has a $250,000 life insurance policy but no access to immediate funds. By selling the policy through a viatical settlement, the family receives a lump sum of up to 70% of the policy value—providing:
Full coverage for all hospice-related expenses without depleting savings
Additional funds to ensure comfort, such as specialized therapies or family travel
Financial support for the spouse and children, reducing stress during this difficult time
Rather than worrying about money, the family focuses on quality time together while ensuring the patient receives the best care possible.
A viatical settlement allows individuals with a terminal illness to sell their life insurance policy for a lump sum, offering financial relief when it is needed most. This option can help cover out-of-pocket hospice expenses, supplement lost income, and provide peace of mind for loved ones. Unlike traditional insurance payouts, viatical settlements offer flexibility – funds can be used for medical expenses, family support, or daily living costs.
How to Begin Hospice Care
If you or a loved one meets hospice eligibility requirements, the next step is to begin care with a hospice provider. Starting hospice services is a straightforward process, but it requires coordination between patients, family members, and healthcare providers.
Steps to Enroll in Hospice Care
1. Speak with a Healthcare Provider
Ask your hospice doctor or primary care physician whether hospice is the right choice based on the diagnosis and expected life expectancy.
2. Choose a Hospice Provider
Research local hospice providers and select one that meets your needs. Hospice services are available at home, in nursing facilities, or in hospice centers.
3. Verify Insurance Coverage
Medicare Part A, Medicaid, and most private insurance companies cover hospice benefits, but it’s important to check for any limitations.
4. Sign a Statement Choosing Hospice Care
Patients must sign a statement choosing hospice care, which confirms that they are opting for palliative care rather than curative measures.
5. Develop a Care Plan
Once enrolled, the hospice care team will create a customized plan focused on symptom management, emotional support, and quality of life.
Hospice care provides comfort and dignity during end-of-life care, ensuring that patients receive the necessary support while reducing stress on their loved ones.
Planning for Comfort and Financial Security
Choosing hospice care is an important decision that ensures patients receive comfort, dignity, and support. Understanding hospice eligibility requirements and available hospice benefits can help families make informed choices about end-of-life care. While many hospice services are covered by Medicare, Medicaid, and private insurance companies, additional expenses may arise.
If you or a loved one is considering hospice care and need financial support, American Life Fund can help. Contact us today to learn more about how a viatical settlement can provide the financial resources you need during this time.
