Economic Profiles of Tomorrow’s Hospice Referral Base

Our senior population is on track to grow from 58 million to 82 million (a 41% increase!) by 2050. That's a huge shift, and it'll bring financial challenges for both patients and providers. For hospices who take non-Medicare patients, it's important to understand your future patients' income levels and assets, so that you can design appropriate payment options.

I've put together some research on key trends in household income, homeownership, and regional differences. This is just a high-level overview, so I've included sources where you can dig in more.

• Future seniors are still income-constrained: Even after adjusting for inflation, median incomes for Americans 65+ will remain near today’s $30K (individual) and $75K (household) through 2050, with Social Security as the main income source for almost 40%—meaning co‑pay capacity stays limited. As a result, hospices may see longer payment cycles and higher rates of self-pay delinquency. Planning for flexible billing plans and early financial counseling can help mitigate revenue risk and preserve access. (source: ACL Profile of Older Americans 2023)

• Homeownership will stay high, offering home-equity-based financing options: Around 80% of adults 65+ own homes today, with projections above 75% by 2050—future patients will continue to favor in‑home hospice services. Hospitals and hospice providers can partner with financial institutions to structure home-equity loans or reverse mortgage-based payment programs. This approach allows families to tap housing wealth while receiving the care they need at home. (source: Harvard JCHS Housing America’s Older Adults 2023)

  
  

• Savings gaps will grow: Retirees face an average shortfall of $115K between expenses and savings, with 41 states at risk of seniors exhausting their assets fully. States with the largest deficits may see increased demand for charity care and payment deferral programs. Hospices should establish dedicated funds and work with community nonprofits to bridge these gaps. (source: Investopedia: Where Seniors Run Out of Money)

  
  

• Dual-eligibility will increase: Dual-eligible patients (Medicare + Medicaid) are projected to exceed 30% of hospice admissions by 2030, requiring robust revenue-cycle processes and specialized billing expertise. Managing dual eligibility often involves navigating differing reimbursement rules and coordinating benefits, which can delay payments. Investing in staff training on payer-specific workflows and deploying automated claim-management tools will reduce denial rates and improve cash flow. (source: KFF Medicaid & LTSS Issue Brief)

I hope this was good food for thought on planning for the future—if you'd like even more sources or research, feel free to reach out to me directly at sherril@moonsethealth.com, I'm happy to share!