Medicare covers hospice medical care, but not room and board the way it covers hospital stays

Medicare Part A pays for hospice services — the nursing, doctors, counselors, and medications you need at the end of life — but it does not pay for the building itself. If you receive hospice in a hospice facility (a dedicated inpatient unit), Medicare covers the medical care inside it. If you receive hospice at home, Medicare covers the visits and supplies. What Medicare does not cover is rent, mortgage, or the cost of living space — whether that space is a hospice facility room, your own home, or a family member's house.

The distinction matters because families often assume "hospice coverage" means the whole bill is covered. It is not. You or your family will pay for housing costs, food, utilities, and personal care aides who are not part of the Medicare hospice team. Understanding what falls on you and what falls on Medicare helps you plan finances and avoid surprises.

Key Takeaways

  • Medicare Part A covers hospice medical services — doctors, nurses, medications, equipment — but not the cost of the room or building itself.
  • If you stay in a hospice facility, you may owe a copay of up to $5 per day for respite care (temporary stays to give family caregivers a break), but not for routine hospice days.
  • Hospice at home is fully covered by Medicare for medical services, but you remain responsible for rent, mortgage, utilities, and food.
  • Medicaid may cover room and board in a hospice facility in some states, but coverage rules vary widely by location.
  • Veterans may have additional hospice benefits through the VA that cover more of the housing cost than Medicare alone.

What Medicare Part A actually covers in hospice

Medicare Part A covers the medical side of hospice care completely — with no deductible and no copay for most services. This includes doctor visits, nursing care, pain medications, counseling (spiritual, grief, and psychological), medical equipment like oxygen or a hospital bed, and home health aide services. If you need a short inpatient stay for symptom management or to give family caregivers a break, Medicare covers that too, though you may owe a copay.

The one exception is respite care — a temporary stay in a hospice facility to relieve family members. Medicare covers respite care, but you pay a copay of up to $5 per day, capped at five consecutive days per stay. After that, the copay stops and Medicare covers the rest of the stay at no cost to you.

What Medicare does not cover is the physical space itself. A hospice facility room, the building's utilities, meals served in the facility, housekeeping, laundry, or any non-medical personal care are not Medicare's responsibility. If you are at home, Medicare does not pay your rent or mortgage, your groceries, or your heating bill.

Hospice in a facility versus hospice at home

The location changes what you pay, but not what Medicare covers medically. In a hospice inpatient facility, Medicare covers all medical care but you (or another payer) must cover room and board. Some facilities bill this as a daily rate, typically $150 to $300 per day depending on the region and the facility's overhead. Some facilities absorb this cost themselves and do not bill patients; others expect insurance or out-of-pocket payment.

In hospice at home, Medicare covers all the same medical services — nurses, doctors, medications, equipment — sent to your house. You do not owe a facility daily rate. However, you remain responsible for your regular living expenses: rent or mortgage, utilities, food, and household maintenance. If you need a paid caregiver beyond what Medicare's hospice team provides, that is also your cost.

Some families choose home hospice specifically because they avoid the facility daily rate, even though they still pay for housing. Others choose a facility because they want round-the-clock nursing and do not want to manage medical equipment at home. The financial picture depends on your situation and what other insurance you have.

Medicaid and state-level room and board coverage

Medicaid rules for hospice room and board vary by state. Some states cover the daily facility cost for hospice patients who meet income and asset limits. Others do not. A few states cover room and board in a hospice facility as part of their Medicaid hospice benefit; most do not.

If you are on both Medicare and Medicaid (called dual may be able to access), your state's Medicaid program may pay the facility daily rate that Medicare does not. You will need to contact your state Medicaid office or your hospice facility's billing department to find out whether your state covers this. Do not assume it does — many states do not, and you could face a bill you did not expect.

Some hospice facilities also have charity care or sliding-scale programs for patients who cannot pay the daily rate. Ask the facility directly whether they offer financial information, and ask before you admit so you know what you owe.

What happens if you cannot pay the facility cost

If a hospice facility bills you a daily rate and you cannot pay, the facility cannot refuse to admit you or discharge you because of inability to pay. Federal law requires hospice programs to provide care regardless of ability to pay. However, the facility can pursue collection or place a lien on your estate after death.

Before you admit to a facility, ask in writing what the daily rate is, whether it is billed to you or to insurance, and what happens if you cannot pay. Ask whether the facility has a financial information program or whether they write off unpaid balances. Some facilities are nonprofit and have more flexibility; others are for-profit and more aggressive about collection.

If you are admitted and later cannot pay, contact the facility's social worker or billing department when ready. Many facilities will work with you on a payment plan or refer you to community resources. Waiting until after discharge to address the bill makes negotiation harder.

Veterans and other insurance that may cover more

If you are a veteran, the VA (Department of Veterans Affairs) may cover hospice care including some room and board costs through its Aid and Attendance benefit or through VA hospice programs. VA coverage is separate from Medicare and may be more generous. Contact your VA regional office or your hospice provider to ask whether VA benefits explore to your care.

If you have a supplemental insurance policy (Medigap), check your policy documents or call your insurer to ask whether it covers hospice facility daily rates. Most Medigap policies do not, but some older plans may have limited coverage. If you have long-term care insurance, it may cover hospice facility costs; again, check your policy or call your insurer.

Life insurance policies sometimes have accelerated death benefit riders that pay out if you are diagnosed with a terminal illness. If you have life insurance, contact your agent to ask whether this applies and whether the payout can be used for hospice costs.

Planning ahead: questions to ask before you need hospice

If you are thinking about hospice or a family member is, ask these questions now rather than in a crisis. Call your Medicare plan or your state's Health Insurance Counseling and Advocacy Program (HICAP) for free help understanding your coverage.

Ask your doctor or a hospice provider: Does Medicare cover the full cost of hospice medical care? What is the daily facility rate if I choose inpatient hospice, and who bills it? Does my state's Medicaid cover room and board? Do I have other insurance that might help? What happens if I cannot pay? Does the facility have financial information? These answers now prevent arguments and surprises later.

Frequently Asked Questions

If I choose hospice at home, do I have to pay for a nurse to stay overnight?

No. Medicare covers hospice nursing visits during the day and on call at night, but not 24-hour live-in nursing. If you want a paid caregiver or nurse at night, that is your cost. Some families hire private caregivers; others rely on family members and call the hospice nurse if symptoms change.

Does Medicare cover hospice in an assisted living facility or nursing home?

Medicare covers the hospice medical services (doctors, nurses, medications) in any setting, including assisted living or a nursing home. However, you still owe the facility's regular room and board charges. Hospice does not replace those bills; it is added on top.

What if I run out of money and cannot pay the hospice facility bill?

The facility cannot refuse or discharge you because of inability to pay. Contact the social worker or billing department to discuss payment plans, financial information, or charity care. Some facilities write off unpaid balances; others pursue collection. Asking early gives you more options than waiting until after discharge.

Can I switch from hospice at home to a facility if I get worse?

Yes. Medicare covers both, and you can move between them. If you start at home and later need 24-hour care, you can transfer to a hospice facility. Be aware that the facility will bill a daily rate from the day you admit, so ask about the cost before you transfer.

Does Medicare cover hospice for children?

Yes, but coverage rules are the same: medical care is covered, room and board is not. Children's hospice is less common than adult hospice, so ask your doctor or contact your state's Medicaid office to find programs in your area. Some children's hospitals have hospice programs; others refer families to adult hospice centers that accept pediatric patients.