chevron-down Created with Sketch Beta.

Voice of Experience

Voice of Experience: April 2024

The Cost of Dying in the U.S

Joan Myers Bondareff


  • For many, it is too costly to die in the United States. Loved ones and caregivers are struggling to find ways to cover end-of-life care.
  • What aspects of end-of-life care are covered by insurance and what are not? 
The Cost of Dying in the U.S

Jump to:

According to a comparative study done by the University of Pennsylvania in 2016 and in JAMA more recently, end-of-life care in the United States costs about the same as that in European nations.  The average cost for the last month of life in a hospital can add up to $32,379 and up to $17,845 a month for hospice care. This has increased recently according to a report from the Federal Reserve Bank of Richmond to $56,300 for the last three months in hospital. 

But I ask –who’s paying for the care? We or the government? And if the government is, how is end-of-life care being addressed?

Based on my recent personal experience, it’s too costly to die in the United States, and the burden is on family caregivers and us to help defray end-of-life care, much less so on Medicare, Medicaid, and insurance policies.

Does Medicare pay for hospice care?  Yes, if it’s in the hospital –less so for at-home care. And most patients want to die at home. 

Does Medicare pay for in-house care such as nurses, occupational and physical therapists? Well, only for three months, and then you have to re-apply and start all over with new therapists and nurses if you’re lucky.

Do you need an aide so you can live comfortably in your own home?  Well, yes, it’s a great idea, but be prepared to pay for the aide yourself. No insurance company pays for this kind of needed care and assistance.

What about long-term life insurance?  You are lucky if the company you signed up with is still in existence when you need it. This happened to my partner and when he actually needed the long-term care, the insurance company was long gone as were most of the proceeds.

What about nursing care in private nursing facilities or assisted living? If you need round-the-clock care, as my mother did, then you have to pay for the night or specialized nurses yourself.  And this can amount to a pretty penny.

What about long-term care in a nursing home? If you expect Medicaid to pay for it, be prepared to give up all your resources and declare bankruptcy, as a friend of mine did, in order to keep his mother in a nursing home at the end of her life. Why should this be the case?

I know a couple who moved to Mexico so they could afford medical care for his mother. The cost was substantially less than that in the United States and, according to the son, was substantially better than the care they had in the States. I guess becoming an ex-pat is one option to avoid this problem. 

Luckily in the cases of my mother and partner, they had the resources to pay for the care themselves. But it did deplete those resources. Why should this be the case after a lifetime of paying for insurance coverage and paying into Medicare?

Is Congress looking at solutions to these problems? I don’t think so. It’s challenging enough to keep Social Security and Medicare solvent, let alone expand Medicare and Medicaid to include end-of-life care.

What else can be done about this problem? Do we have to go broke first or move to another country where health care is cheaper or spend all our resources on end-of-life care? What are some of the solutions?  

I recommend:

  • Expanded Medicare coverage to include palliative and hospice care and needed assistance in the home
  • Expanded Medicaid coverage so the family of the patient does not have to declare bankruptcy to provide coverage for a loved one
  • Establishment of a bipartisan Commission to study end-of-life-care in the United States and make recommendations for what needs to be changed
  • Congressional review of our system of long-term insurance policies to make sure these companies remain solvent -these are only reviewed by state boards of insurance now
  • A pledge by SLD to work with AARP and other senior citizen organizations to make sure Americans can die in peace and at home and not have to spend their life savings to do so.

Yes, this is all costly, but what is the alternative?   

These are the personal views of the author and are not intended to provide legal advice on these important questions of end-of-life care.