Paying for Hospice Without Medicare

If you don't have Medicare, hospice care is still within reach. Medicaid covers hospice in most states, the Department of Veterans Affairs covers it for eligible Veterans with no copay, and many private and Marketplace health plans include a hospice benefit. Some community hospices also offer charity or sliding-scale care. The right pathway depends on your coverage and situation.

Medicare is the most familiar way hospice is paid for, but it is far from the only way to cover it. As of July 2026, the pathways below are the main ways families without Medicare pay for hospice.

Medicaid hospice coverage

Medicaid is the joint federal-and-state health program that covers hospice for many people who do not have Medicare, including younger adults and children. According to Medicaid.gov, the hospice benefit is an optional state plan service that includes nursing, medical social services, physician services, counseling, short-term inpatient care, medical supplies and appliances, home health aide and homemaker services, and physical, occupational, and speech-language therapy — a set of services similar to Medicare's.

Because Medicaid is administered by each state, the details differ from place to place, and the great majority of states offer the hospice benefit. To use it, a person elects hospice by filing an election statement with a specific hospice and acknowledging that other Medicaid services aimed at curing the terminal condition are waived, Medicaid.gov explains. One important exception: Medicaid-eligible children under age 21 who elect hospice can receive curative treatment and hospice care at the same time. Because eligibility and exact coverage vary, check your state's Medicaid program for specifics.

Some people have both Medicare and Medicaid. For them, Medicare's hospice benefit covers the care itself, while Medicaid may help with costs Medicare does not — most notably room and board in a nursing facility. If that describes your situation, a hospice's social worker can explain how the two programs fit together and help you avoid paying for something one of them already covers.

VA hospice care for Veterans

Veterans have a clear and generous pathway. Hospice care is part of the VA's Standard Medical Benefits Package, and the VA states that all enrolled Veterans are eligible if they meet the clinical need for the service.

The cost picture is especially straightforward: there are no copays for hospice care, whether it is provided directly by the VA or by an organization with a VA contract, according to VA.gov. That means the VA can arrange hospice in a Veteran's own home, in a VA facility, or through a community hospice under contract, without a copay in any of those settings. Families of Veterans should also see hospice for veterans for guidance specific to service-connected illness and VA coordination.

Private and Marketplace health insurance

Private plans — including those bought through the Affordable Care Act Health Insurance Marketplace — often cover hospice, but it is not guaranteed. Hospice is not one of the ten essential health benefits that Marketplace plans are required to cover, as the list on HealthCare.gov shows. That means a plan can include hospice, but it is not a federal requirement.

In practice, many private and Marketplace plans do offer a hospice benefit as an additional service, and covered services and cost-sharing vary by plan and by state. The reliable move is to read the plan's own documents or call the insurer and ask two questions: Is hospice covered, and what will I owe? If a plan's hospice coverage is limited, Medicaid or VA benefits may still apply alongside it.

Charity care and community hospices

Some nonprofit and community hospices offer charity care or sliding-scale fees, funded through donations, grants, and community support. This varies widely from one hospice to another and is not a government benefit, so it cannot be assumed. It can, however, make a real difference for families who fall between coverage options.

The most reliable step is to ask a specific hospice directly what financial assistance it offers. A hospice's admissions or social-work staff can explain which programs you might qualify for and can often help you apply for Medicaid or other coverage at the same time. Asking is not an imposition; helping families navigate payment is part of what hospice teams do.

If you're uninsured or under 65

Being uninsured or younger than 65 does not close the door on hospice. The main pathways to check, in a sensible order, are:

1. Medicaid — apply or check eligibility, since hospice is covered in most states and coverage can begin quickly for those who qualify.
2. VA benefits — if the person is a Veteran, enrolled Veterans can access VA hospice with no copay.
3. A Marketplace or private plan — if the person has one, confirm whether hospice is included and what it costs.
4. The hospice itself — ask about charity care, sliding-scale fees, and help applying for coverage.

For comparison, when Medicare does cover hospice, you pay nothing for covered services, according to Medicare.gov — a useful benchmark when weighing other options. To see how the numbers compare, read how much hospice costs, and to understand the benefit Medicaid and private plans generally model, see does Medicare cover hospice.

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