Ways to help pay for palliative, hospice, skilled nursing, and other end-of-life care

End-of-life care can be unexpected, complicated and expensive. As healthcare costs continue to rise in America, it is important to know what financing mechanisms are available to you or your loved one as the end of life nears. In this guide, you’ll find an overview of ways to help pay for end-of-life care.

End of life desires, services, options, and coverage

Where people decide to live out their final days directly impacts their end-of-life experience and cost of care. A study conducted by the New England Journal of Medicine found that in 2017, the number of people who chose to die at home had surpassed those who did so in a hospital. This was the first time in the modern era that the majority of people weren’t passing away in hospitals or other facilities. 

While most Americans likely prefer to die at home, there are still many instances when it isn’t possible, and they have to pass in a hospital or a facility. Medicare is the single largest payer for end-of-life care. However, other options, including Medicaid; the Veterans Administration (VA) and Department of Defense; private health insurance; long-term care insurance; and direct pay, can help cover the costs for end-of-life care. 

• Hospital Care:

  Death may happen suddenly, from an accident, a medical complication, or an emergency that led to a hospital admission. This admission may lead to tests, imaging, surgical procedures, or other advanced interventions with the hope of saving a life. This could also lead to an admission into the intensive care unit (ICU), which is extremely costly. 

  Original Medicare Part A covers inpatient hospital stays, services include general nursing, labs, semi-private room, meals and medications that you take while in the hospital. Medicare Part B will cover physician services while you are in the hospital. It is important to verify that the services proposed will be covered by Medicare. 

• Skilled Nursing Facility:

  While some individuals may require nursing-level facility care, there are financial and policy constraints that limit access to end-of-life care in a nursing facility. In skilled nursing homes or assisted living facilities, Medicare will only cover hospice related services, but not room and board. According to Genworth's Cost of Care Survey, in 2019 a private room in a nursing home costs on average $8,365 per month. Some individuals that plan to move to a skilled nursing facility but can’t afford the monthly cost may qualify for Medicaid spend down to enroll in Medicaid to help pay for costs. Overall, this can be extremely cost prohibitive resulting in individuals experiencing their final days in a hospital. Find out more about spend downs and potential eligibility by clicking here.

• Palliative and Hospice Care Services: 

  Both palliative and hospice care are focused on increasing quality of life by providing comfort care, treating pain, and alleviating the symptoms of individuals with a terminal illness who are nearing end-of-life. Palliative and hospice care have physical, social, emotional and spiritual aspects to them as well. The main difference between hospice and palliative care is when services can begin and with regard to curative treatment. Palliative care can begin upon diagnosis and at the same time as curative treatments, while hospice requires curative treatment to conclude and a life expectancy of six months or less. However, if an individual lives longer than six months, their care team can recertify and extend their care for another six months. 

  Private insurance plans may cover all or part of Palliative care services. It is best to contact the plan directly to confirm the coverage.

  Original Medicare Part A and Part B will also cover services under specific conditions. For example, palliative care is only covered when you have a life expectancy of six months or less and have chosen palliative care over curative care.

  This is also the time you would qualify for hospice care. Your hospice care team will be led by a Medicare assigned physician, who approves all services moving forward. You can search for this using Medicare’s Hospice Compare tool.

  Medicaid is administered at the state level, so each state benefit may differ in what palliative care services are covered. 

This guide simply provides an overview of ways to pay for end-of-life care. If you are looking for additional assistance understanding end-of-life costs, talk to our concierge service here at Peacefully. The concierge service can help with referrals to trusted professionals, offering case-specific advice, recommendations, and coordination for you. For more about our concierge service or to schedule a free consultation, click here.

— Lesley Hellow