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. In this guide, you’ll find an overview of ways to help pay for end-of-life care.

End-of-Life Care

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 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. 

While most Americans likely prefer to die at home, there are still many instances when it isn’t possible. 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. 

End-of-Life Options

• Hospital Care: Death may happen suddenly, from 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 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. Palliative care is covered if you have a life expectancy of six months or less. This is when you have chosen palliative care over curative care. This is also the time you would qualify for hospice care. A hospice care team is 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, each state benefits 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, sign up for Peacefully today here.