Yes, Medicare covers hospice care in a skilled nursing facility, but with specific conditions

Medicare Part A covers hospice care in a skilled nursing facility (SNF) when your doctor and the hospice medical director both agree you have a terminal illness with a life expectancy of six months or less. The facility must be Medicare-certified, and you must be enrolled in a Medicare-approved hospice program. Medicare pays the hospice directly for your care, not the skilled nursing facility itself.

The key difference from regular SNF care is that once you elect hospice, Medicare shifts focus from curative or rehabilitative treatment to comfort and symptom management. You keep your Medicare coverage, but the hospice team — not the SNF staff alone — directs your medical care plan.

Key Takeaways

  • Medicare Part A covers hospice in a skilled nursing facility when a doctor certifies a terminal diagnosis with six months or less to live.
  • You must formally elect hospice through a Medicare-approved hospice program; straightforward being in an SNF does not automatically trigger hospice coverage.
  • The hospice team manages your care plan, though the SNF provides the room, meals, and nursing support.
  • You may have out-of-pocket costs for non-hospice services, medications unrelated to your terminal condition, and any SNF charges above what Medicare allows.
  • You can revoke your hospice election at any time and return to curative care if your condition changes.

How Medicare pays when you are in an SNF and on hospice

When you are in a skilled nursing facility and enrolled in hospice, Medicare Part A pays the hospice program a daily rate to cover hospice services. That rate varies by region but covers the hospice nurse visits, doctor oversight, medications related to your terminal condition, medical equipment, and counseling. The SNF continues to bill Medicare Part A for your room, board, and basic nursing care — but at a reduced daily rate because hospice is now managing your medical treatment.

You do not pay a copay or coinsurance for hospice services covered by Medicare. However, you remain responsible for any costs the SNF charges that exceed Medicare's allowed amount, and for medications or treatments unrelated to your terminal illness. If the SNF charges a daily rate higher than Medicare's skilled nursing benefit covers, you may owe the difference.

What happens to your SNF stay when you choose hospice

Choosing hospice does not automatically end your skilled nursing facility stay. You can remain in the SNF for as long as your condition requires, and Medicare will continue to cover your room and board under Part A. However, the SNF's role changes: instead of working toward discharge and rehabilitation, the focus becomes comfort, dignity, and end-of-life care.

The hospice team — which includes a doctor, nurses, social workers, and chaplains — works alongside SNF staff to manage your symptoms, pain, and emotional needs. The SNF provides the physical space and daily care, while hospice directs the medical plan. Some SNFs have more experience with hospice patients than others, so it is worth asking the facility whether they regularly work with hospice teams and how they coordinate care.

Medications and equipment covered under hospice

Medicare hospice covers medications directly related to managing your terminal condition and symptoms — such as pain relievers, anti-nausea drugs, or medications for breathing difficulty. The hospice program supplies these, and you do not pay for them. Medical equipment like oxygen, a hospital bed, or a wheelchair also falls under hospice coverage when it is needed for comfort.

Medications for conditions unrelated to your terminal illness — such as blood pressure medicine or diabetes medication — may still be covered by Medicare Part B or Part D, depending on the drug and your coverage. Ask your hospice team and the SNF which program is paying for each medication, because the source of payment affects what you owe out of pocket.

When you might have costs in an SNF on hospice

Your main out-of-pocket costs in a skilled nursing facility on hospice are:

  • Any daily SNF charges above Medicare's allowed amount (if the facility charges more than Medicare reimburses).
  • Medications for non-terminal conditions, if they are covered under Part B or Part D rather than hospice.
  • Any services or items the SNF provides that are not part of the standard Medicare benefit — for example, a private room upgrade or specialized therapies not related to your terminal diagnosis.
  • Costs related to care after you revoke your hospice election and return to curative treatment.

Before you elect hospice, ask the SNF and the hospice program to explain what costs you may face. Some SNFs are more transparent about this than others, and it helps to have the conversation in writing so you have a record.

How to elect hospice while in a skilled nursing facility

To enroll in hospice while in an SNF, your doctor must refer you to a Medicare-approved hospice program. You can ask your SNF doctor for a referral, or you can contact a hospice program directly. Once you choose a program, you sign a form stating that you understand hospice is for comfort care, not curative treatment, and that you are giving up certain Medicare benefits (like hospital care for your terminal condition).

The hospice program then contacts Medicare to confirm your enrollment. This process usually takes a few days. Your hospice election takes effect on the date you sign the form, and Medicare begins paying the hospice program from that date. You do not need permission from the SNF to elect hospice, though the facility must cooperate with the hospice team once you have enrolled.

Keep a copy of your hospice election form. If you ever want to revoke hospice and return to curative care, you will need to notify both the hospice program and Medicare in writing.

What changes if you revoke your hospice election

You can revoke your hospice election at any time, for any reason. If you do, Medicare stops paying the hospice program and returns to paying for curative care — either in the SNF or in a hospital, depending on your needs. Your doctor and the SNF will work with you to resume treatment aimed at recovery or managing your condition, rather than comfort alone.

Revoking hospice does not affect your Medicare coverage or your right to enroll in hospice again later if your condition changes. However, if you revoke and then want to re-enroll in hospice, your doctor will need to recertify that you have a terminal diagnosis with six months or less to live. This recertification can take a few days, so there may be a gap in hospice coverage.

Frequently Asked Questions

Can I stay in the skilled nursing facility after I elect hospice?

Yes. Electing hospice does not require you to leave the SNF. Medicare continues to cover your room and board under Part A, and the hospice team works with SNF staff to manage your care. You can remain in the facility for as long as your condition requires.

Do I have to choose a specific hospice program, or can I pick any one?

You can choose any Medicare-approved hospice program. Ask your doctor or the SNF for a list of programs in your area, or search the Medicare Hospice Compare tool on Medicare.gov. Different programs may have different services, visiting schedules, and staff availability, so it is worth comparing a few.

What if my family disagrees with my hospice election?

The decision to elect hospice is yours alone, unless you have named someone as your healthcare power of attorney. If family members have concerns, ask the hospice team to meet with them and explain what hospice care involves. Many families find that hospice improves quality of life and reduces suffering, even if they were uncertain at first.

Will Medicare stop paying for my SNF care once I elect hospice?

No. Medicare Part A continues to cover your room, board, and basic nursing care in the SNF. The hospice program pays for hospice-specific services like pain management and counseling. Both payments happen at the same time while you are in the facility.

What happens to my hospice coverage if I leave the skilled nursing facility?

Your hospice coverage continues whether you are in an SNF, at home, or in an inpatient hospice facility. Medicare pays the hospice program the same daily rate regardless of where you receive care. If you move to a different location, notify your hospice program so they can arrange care in your new setting.