Understanding how hospice and palliative care are paid for is one of the most common questions families have. The good news is that most patients have coverage through Medicare, Medicaid, or private insurance. Below, we explain each option in detail.
Medicare Hospice Benefit (100% Coverage)
The Medicare Hospice Benefit covers virtually all hospice care services at no cost to the patient if they have Medicare Part A coverage. This is the most comprehensive hospice coverage available and includes:
Covered Services:
Professional hospice care fees (nursing, physician, aide visits)
Medications related to the terminal illness and symptom management
Durable medical equipment (hospital bed, wheelchair, commode, oxygen)
Medical supplies related to the terminal diagnosis
Social work services
Spiritual care and chaplain services
Bereavement counseling for family members (up to 13 months)
Short-term inpatient care for pain and symptom management
Respite care (up to 5 consecutive days) to give caregivers a break
Physical, occupational, and speech therapy as needed
Important: Patients receiving hospice care can still receive Medicare benefits for health problems unrelated to their terminal illness. You do not give up your Medicare coverage by electing hospice.
Small Co-pays: You may be required to pay a small co-pay for some prescription drugs (no more than $5 per medication) and for respite care (5% of the Medicare-approved amount).
Medicaid Coverage
Most state Medicaid programs, including Pennsylvania Medicaid, pay for hospice care services. Medicaid hospice benefits generally mirror the Medicare Hospice Benefit. If you or your loved one is enrolled in Medicaid, contact us and we will verify your coverage and explain your benefits.
Private Health Insurance
Most private health insurance plans pay for hospice care services, as most follow Medicare guidelines. Coverage typically includes the same services covered under Medicare. We recommend contacting your insurance company to verify your specific hospice benefit, or let our care coordinators handle this for you — we are experienced in navigating insurance verification.
Veteran Benefits
Veterans may be eligible for hospice care through the Department of Veterans Affairs (VA). As a proud We Honor Veterans partner, Pinnacle is experienced in serving veterans and can help navigate VA benefits. Veterans may receive hospice care from Pinnacle while also maintaining their VA healthcare benefits.
Who Pays for Palliative Care?
Most insurance plans, including Medicare and Medicaid, cover the costs of palliative care. Since palliative care is provided alongside curative treatments, it is typically billed through your regular health insurance as specialist medical care. Coverage varies by plan, and our team can help you understand your specific benefits.
Charitable Care
Pinnacle is committed to ensuring that no one is denied hospice care due to inability to pay. We offer charitable care for patients who do not have insurance coverage or who face financial hardship. Contact us to discuss your situation — we will work with you to ensure your loved one receives the care they need.
We Handle the Details
We recognize that dealing with insurance and payment questions during a difficult time adds unnecessary stress. Our care coordinators will handle insurance verification, benefits explanation, and all administrative details so you can focus on what matters most — spending time with your loved one.
