Yes, Medicare covers hospice in a skilled nursing facility, but only under specific conditions
Medicare Part A pays for hospice care in a skilled nursing facility (SNF) if you meet two requirements: you must be enrolled in a Medicare hospice benefit, and the hospice agency must have a contract with that specific facility. The hospice team — not the SNF — directs your care, though the facility provides the room and basic services. This is different from regular SNF care, where Medicare pays the facility directly for skilled nursing and rehabilitation.
The key difference is that once you elect hospice, Medicare stops paying for curative treatment and rehabilitation services at the SNF. Instead, it covers comfort care, pain management, and support for you and your family. The hospice agency bills Medicare for those services, while the SNF continues to provide room, meals, and basic nursing information.
Not every SNF has a hospice contract, and not every hospice serves every facility. Before choosing a hospice or SNF, you need to confirm they work together. If they do not, you may have to transfer to a different facility or choose a different hospice agency.
Key Takeaways
- Medicare Part A covers hospice services in an SNF only if the hospice agency has a formal contract with that facility.
- Once you elect hospice, Medicare stops paying the SNF for skilled nursing and rehabilitation, and the hospice team takes over your medical direction.
- The SNF still provides your room, meals, and basic care, but the hospice agency bills Medicare for comfort care, medications, and support services.
- You must ask both the SNF and the hospice whether they have a working relationship before you commit to either one.
- If the SNF and hospice do not contract with each other, you will need to choose a different facility or a different hospice agency.
How Medicare pays when hospice and SNF care overlap
When you are in an SNF and enrolled in a Medicare hospice benefit, Medicare Part A covers two separate things. The hospice agency receives a daily rate from Medicare to provide hospice services — pain management, medications, counseling, and end-of-life support. The SNF receives a separate daily rate to provide room and board, meals, laundry, and basic nursing care that is not related to your hospice diagnosis.
This dual-payment system works only if the hospice and SNF have a written agreement in place. The agreement spells out which services each provider delivers and how they coordinate. Without it, confusion over billing and care can delay treatment or leave gaps in your support.
You do not pay a copay or coinsurance for hospice services covered by Medicare Part A. The SNF room and board are also covered at no cost to you during your hospice stay, as long as you remain may be able to access for Part A coverage. If you have a Medigap or Medicare Advantage plan, check with them about any additional coverage or restrictions they may impose on hospice in an SNF setting.
What you need to verify before choosing an SNF or hospice
Before you or your family member enters an SNF with the intention of receiving hospice care, contact both the facility and the hospice agency directly and ask: "Do you have a contract to work together?" Do not assume they do. Many SNFs work with only one or two hospice agencies, and many hospice agencies do not serve all facilities in an area.
Ask the SNF which hospice agencies they contract with. Ask the hospice agency which SNFs they serve. If the two you want do not overlap, you have three options: choose a different SNF, choose a different hospice, or receive hospice care at home or in a hospice facility instead of an SNF.
Also ask whether the SNF has a hospice care unit or whether hospice patients are mixed with rehabilitation patients. Some facilities have dedicated hospice wings with quieter environments and staff trained specifically in end-of-life care. Others integrate hospice patients throughout the building. Neither is inherently better, but the setup affects the environment and the level of specialized attention you receive.
What happens to your SNF care once you elect hospice
When you enroll in a Medicare hospice benefit while in an SNF, your care plan changes when ready. The hospice physician becomes your primary doctor for your terminal condition. The SNF nursing staff continues to provide daily care — medications, wound care, hygiene, meals — but the hospice team directs the goals and approach.
Medicare stops paying the SNF for skilled nursing services aimed at recovery or rehabilitation. If you were admitted for physical therapy after a hip fracture, that therapy stops. If you were receiving wound care to heal a pressure ulcer, the focus shifts from healing to comfort. The SNF can still provide basic nursing care, but not the intensive rehabilitation services that normally justify a skilled nursing stay.
This shift can be difficult for families who hoped the SNF stay would lead to recovery. It is important to discuss with the hospice team and the SNF what this change means for your daily routine, your visitors, and your comfort. Some SNFs are experienced at this transition and handle it smoothly. Others struggle with the change in focus.
Costs and coverage limits you should know
Medicare Part A covers hospice services in an SNF with no copay or deductible. However, you must have Part A coverage active, and you must have been in the SNF for at least three days before electing hospice for Medicare to cover the full stay. If you elect hospice on day two of your SNF stay, Medicare may not cover the SNF room and board retroactively.
Medicare hospice benefits are not time-limited, but they are condition-specific. A doctor must certify that you have a terminal illness and a life expectancy of six months or less. If you improve and your condition no longer meets that standard, you can be discharged from hospice and return to regular SNF care or go home. If you decline further and your condition worsens, hospice continues to cover your care.
If you have a Medicare Advantage plan instead of Original Medicare, hospice coverage works the same way — Part A still covers it — but you should contact your plan to understand any additional rules or restrictions they may have. Some Advantage plans require you to use hospice agencies within their network.
Common situations that create confusion
One frequent misunderstanding: families sometimes think that electing hospice means leaving the SNF. In fact, you can stay in the SNF and receive hospice care there. The hospice team visits regularly, coordinates with the SNF staff, and manages your medical needs while the facility provides your daily living support.
Another source of confusion is the difference between hospice in an SNF and hospice in a separate hospice facility. Some hospice agencies operate their own inpatient units or partner with dedicated hospice centers. These are different from SNFs. If you want hospice in a dedicated hospice setting rather than an SNF, you can request that, and Medicare will cover it the same way — but you would be in a different type of building with different staff.
A third common issue: families do not realize that once hospice is elected, certain treatments stop. Antibiotics for infections, blood transfusions, and hospital transfers for acute problems are typically not part of hospice care unless they directly support comfort. If you or your family member want to continue aggressive treatment, hospice may not be the right choice at that time.
How to start the process
If you are in an SNF and your doctor believes hospice is appropriate, ask your SNF social worker or care coordinator to help you identify hospice agencies that contract with that facility. The social worker can also explain what electing hospice means for your care and answer questions about the transition.
Once you have identified a hospice agency that works with your SNF, you can meet with a hospice representative to discuss your wishes, your medical history, and what hospice care will look like. You will sign a form electing the hospice benefit, and Medicare will be notified. The hospice team typically begins visiting within 24 to 48 hours.
You can change your mind about hospice at any time. If you decide you want to pursue treatment again or move to a different setting, you can revoke your hospice election. Medicare will resume paying for regular SNF care or other services. There is no penalty for changing your decision.
Frequently Asked Questions
Can I receive hospice in an SNF if I have a Medicare Advantage plan?
Yes. Medicare Part A covers hospice regardless of whether you have Original Medicare or a Medicare Advantage plan. However, contact your Advantage plan to confirm whether they have any additional requirements, such as using a hospice agency within their network or obtaining prior authorization.
What if the SNF and hospice agency do not have a contract?
If they do not contract with each other, you will need to choose a different SNF, a different hospice agency, or receive hospice care in a different setting such as your home or a dedicated hospice facility. The SNF social worker can help you identify hospice agencies they do work with.
Do I have to stay in the SNF if I elect hospice, or can I go home?
You can choose to receive hospice anywhere — in the SNF, at home, or in a dedicated hospice facility. If you want to leave the SNF and receive hospice at home, you can do that. Medicare covers hospice services in all three settings the same way.
Will the SNF still provide physical therapy if I am on hospice?
No. Once you elect hospice, Medicare stops paying for rehabilitation services like physical therapy. The SNF can still provide basic nursing care and comfort measures, but not therapy aimed at recovery or improvement.
What if I change my mind about hospice after a few days?
You can revoke your hospice election at any time, for any reason. Medicare will resume paying for regular SNF care or other services. Tell your SNF care coordinator or the hospice agency that you want to stop hospice, and they will handle the paperwork with Medicare.