Comparing Hospice Care: Find and Choose a Provider

Key takeaways:

Medicare’s Care Compare website, along with other resources, can help you evaluate hospice providers.
Before you commit to a hospice provider, ask as many questions as you can. Hospice organizations and Medicare have suggested interview questions you can use.
Most hospice care is covered up to 100% by insurance, including Medicare, Medicaid, and private health insurance plans.

The decision to begin hospice care is a difficult and highly emotional one. If you or a loved one are terminally ill, hospice can provide specialized care and comfort during this very challenging time.

But figuring out where to get hospice care can be daunting. A specific facility may come recommended by a doctor or friend. Or, you may want to get hospice care at home, as many people do. To help maximize your quality time later, it can be useful to learn in advance about your hospice care options.

Comparing hospice agencies

As a person’s health declines during their final weeks or months, they may need different kinds of care. So Medicare requires hospices to offer four levels of care:

Routine home care: For a person who’s generally stable, with symptoms such as pain or nausea under control
General inpatient care: 24/7 care to treat severe symptoms in a hospital or other inpatient facility, when necessary
Continuous home care: More intensive nursing care during a time of crisis
Respite care: A stay at an inpatient facility for a few days so that caregivers can take a break

However, the quality of that care can vary from hospice to hospice. Online data tools and resources can give you a sense of how a hospice program compares to others in your area (and around the country). The best place to start is with Medicare’s Care Compare online tool.

What’s the Care Compare tool?

Care Compare is easy to use and a dependable source of information about hospice options near you. It lists and maps more than 3,800 Medicare-certified hospices, scoring each one and relating the scores to statewide and nationwide ratings. The tool lets you select three hospices at a time to compare. You can learn:

How often a hospice deals with common end-of-life conditions such as cancer, dementia, heart disease, and stroke
Whether the hospice has recent experience dealing with Medicaid patients
How many people the staffers are responsible for on an average day
How families and caregivers rate the staff on respect, communication, and timely pain management, among other things

Are the Care Compare ratings the best measure of care?

Of the current online options, Care Compare provides the most comprehensive ratings and the most reliable hospice facts. The information stays up to date because the government penalizes hospices that don’t submit their quality data (though a 2019 study suggests that for-profit hospices are less likely to comply). So, Care Compare is very helpful for looking at the big picture. But for a more detailed look, you may want to consult other sources.

How to get more information on hospice providers

National Hospice and Palliative Care Organization (NHPCO): This website offers a searchable hospice finder tool that lists each facility’s available programs and services. It also has a list of questions that you can ask when interviewing a hospice.
Hospice Foundation of America: This nonprofit also provides a list of questions to ask as you’re considering your selection.

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey: This monthly national survey asks patients’ families or friends 47 questions about their hospice experience. As of August 2022, a hospice’s overall star rating should appear on Care Compare as the family caregiver survey rating.
State hospice association websites: Some associations provide website directories of their members and information about hospice providers.
Your state’s health department: Check to see if a hospice you’re considering has had complaints filed against it.
A hospice agency’s own records: Ask to see the hospice’s latest state or Medicare inspection report.

What should I look for when choosing a hospice provider?

Some factors to consider include:

Accreditation, licensing, or certification: The hospice should be accredited by the Joint Commission or by the Community Health Accreditation Program. This signals that the hospice meets a standard of care set by a knowledgeable third party.
Services offered: Some hospice agencies provide bereavement services, such as counseling for the terminally ill person’s loved ones.
Location: If you’re planning to receive care at a facility, you may wish to choose one that’s convenient for your caregivers and easily reached by on-call medical providers.
Insurance issues: If you’re among the few whose hospice care is covered by private insurance, you’ll want to discuss your plan benefits with the hospice staff.

Who pays for hospice care?

Generally, insurance covers almost all the costs of hospice care. About 90% of people in hospice are covered through Medicare. The rest are paid for by Medicaid, private insurers (such as employer health plans), funds from family and friends, or through out-of-pocket self-pay. Many hospice programs also provide care to people who cannot pay for it; donations typically cover those costs.

Does Medicare or private insurance cover hospice care?

Yes. Medicare, Medicaid, the Veterans Health Administration, and private insurance offer hospice benefits. Medicare’s benefit is consistent across the country, but Medicaid’s varies by state.

Medicare pays for hospice care if the provider meets Medicare’s certification requirements. (More than 92% of hospices are Medicare-certified.) These rules specify the minimum care that a hospice must provide, without regard for insurance coverage.

Medicare hospice coverage

Part A of original Medicare will cover up to 100% of the costs related to hospice care. It will also cover hospice costs if you are enrolled in another Medicare plan or a Medicare Advantage (MA) plan. You can remain in your MA plan and still get original Medicare’s hospice coverage as long as you continue to pay the MA premiums.

Who is eligible for Medicare hospice coverage?

To qualify for hospice coverage, a person with Medicare Part A must do three things:

Have a hospice doctor or regular physician certify that they’re terminally ill and are not expected to live more than 6 months
Stop all curative measures and treatments and adopt a “comfort care” hospice approach
Sign a statement to confirm they’re choosing hospice care instead of treatments for their terminal condition

What’s covered by the Medicare hospice benefit?

The Medicare hospice benefit covers everything related to the terminal illness. This extends to all items and services for pain relief and symptom management.

The benefit also covers a long list of other possible needs, including:

Medical care, nursing care, and social services
Hospice aide and homemaker services
Physical and occupational therapy
Medical equipment for pain relief, such as wheelchairs or walkers
Speech-language pathology services
Social worker services
Dietary counseling
Short-term inpatient care
Short-term respite care
Spiritual and grief counseling

Medicare supplement insurance (Medigap) can help with your medication and respite care costs.

Cost

Even with Medicare’s extensive hospice benefit, there are still some out-of-pocket expenses. These will include:

A copay of $5 or less for medications for pain and symptom management
5% of the Medicare-approved amount for respite care
Your monthly premiums for Part A (if necessary) and Part B
Deductibles and coinsurance for Medicare-covered treatments that aren’t related to your terminal condition

Also, room and board costs aren’t covered if you get hospice care at home, a nursing home, or other care facility.

Medicaid hospice coverage

Medicaid provides a hospice benefit, too, in all 50 states and D.C. It resembles the Medicare benefit in scope, but eligibility requirements and other specifics may vary between states. For example, states can define “terminally ill” and “life expectancy” differently. To find out the requirements in your state, you can contact your state Medicaid agency.

Who's eligible for Medicaid hospice coverage?

If you have health insurance through Medicaid, you can also get hospice care through Medicaid. To begin getting hospice care, you must:

Have a physician certify that you are terminally ill, with a life expectancy that meets that state’s hospice criteria
Stop curative treatment for your illness, if you are age 21 or older
Submit a statement to the hospice that confirms you know you are stopping treatment for your terminal illness

Cost

Similar to Medicare, in many states Medicaid may cover 100% of hospice care. Your state Medicaid agency can provide details specific to your location.

Private insurance hospice coverage

Many private health insurance plans cover hospice and provide care that meets Medicare’s standards. But your employer’s health plan may have additional requirements. Talk to your plan administrator and your hospice agency about what costs are not covered by your policy.

The bottom line

Choosing the best hospice care for yourself or a loved one can be a complex and emotionally charged task. You can get useful information from web search tools, online directories, hospice organizations, and conversations with other people who have used hospice.

Fortunately, almost all hospice costs are covered by insurance, whether Medicare, Medicaid, or private plans.

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Written by:

Jeanne Dorin McDowell

Jeanne Dorin McDowell is a journalist and senior editor who has written for major national publications and digital outlets. She is a former correspondent for Time Magazine, and her freelance stories have been published in The New York Times, Scientific American MIND, and Smithsonian, among others.

Edited by:

Caren Weiner, MSIS

Caren Weiner, MSIS, started as a journalist in 1986. She worked for Money magazine and co-wrote its “Guide to the 1986 Tax Reform Act.” From the start, she immersed herself in data on mutual fund total returns and marginal tax rates.

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