How Much Does Hospice Care Cost Out of Pocket

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Last Updated on August 4, 2021 by Frank Davis

You may be in the process of trying to get hospice care and are researching the costs of service. The great part of hospice care is that if you have insurance such as Medicare, Medicaid, or private insurance, hospice is covered 100%. If you are uninsured because you can not afford it, hospice care will provide social services to assist you in applying for an insurance.

Many people still wish to know what the cost of care is if they must pay for it themselves without an insurance plan. A Medicare hospice patient will spend an average of $12,200 in 2018 – according to the National Hospice and Palliative Care Organization. Is that to say that you will also pay that amount? No, that amount can be higher or lower, depending on the number of days and the level of care your loved one needs to be in to manage his or her pain and symptoms.

In this article we will give an overview on how much it may cost you out of pocket, without insurance, when getting hospice care.

How Much Does Hospice Care Cost Per Day or Hourly

Based on NHPCO, 98.2% of the days of care received in 2018 were at the Routine Homecare (RHC) level. The rates as shown above are structured depending on the four levels of care. To know more about the rates please read below:

1. In level 1, the first 60 days of Routine Home Care are paid at a high rate of $199 per day. For days 61 and beyond, hospice care is paid at a low rate of $157 per day. Reimbursement is not determined by the volume or intensity of services provided on any particular day. At level 1, nurses visits periodically about 2 to 3 times a week.
2. At level 2, the hospice is paid the continuous home care rate when providing ongoing care to the beneficiary in his or her home only in a period of crisis. An acute crisis is described as an episode in which the patient is experiencing uncontrollable pain and symptoms. The patient must be provided nursing care by a registered nurse (RN) or licensed practical nurse (LPN, LVN) for a minimum of eight hours per day.
3. When the patient is receiving Short Term General Inpatient care at a Medicare-certified hospice facility, hospital, or skilled nursing facility, hospices are entitled to receive payment at the Short Term General Inpatient Rate. In the event of a level 2 medical crisis persisting, it typically will be moved to level 3, which is the most advanced level of hospice care during a medical crisis. At Short Term General Inpatient Care they normally have 24 hour around the clock nurses and staff to assist in the crisis. As soon as the crisis is over, patients are normally able to return back home at level 1.
4. Level 4 patient Inpatient Respite Care is paid daily. This level is normally for caregivers who require a break from hospice care. It is provided at a Medicare or Medicaid certified hospital, skilled nursing facility, or hospice facility. Generally, Inpatient Respite Care can be provided for a period of up to five consecutive days. However, this may only occur once every 60-90 days.

Hospice Room and Board Rates

Short-Term Inpatient Care (different from General Inpatient Care) is covered by Medicare, but only in the event of a crisis. This type of care is normally covered for 5 days or less.

Medicare does not cover room and board when you get hospice care in your home or another facility. In case you are considering moving or residing in a General Inpatient Care facility, this will not be covered by Medicare. You will be responsible for paying for the room and board out of pocket. On average, room and board costs within a range of $2,500 to $5,000 per month, depending on whether you are living in a shared or private room, and your location. Many families are choosing to opt for hospice care at home, in order to avoid the high costs that may come with General Inpatient Care facilities.

Conclusion

The point of hospice care is to alleviate problems that you may have, that includes the financial aspect of it. You should not have to worry about being able to afford hospice. You have enough to worry about already. It is not a one size fits all price and for that reason it may be confusing. Fortunately, if you have insurance coverage either through Medicare, Medicaid, or a private insurer, hospice care is insured to full coverage and should give you some relief from the financial burden you might have felt. Not having to worry about payments or costs of services, ahh, such a relief!