Medicare covers most hospice costs, but you pay a small copay for medications and equipment rentals

Medicare Part A covers hospice care when a doctor certifies that you have six months or less to live. You pay nothing for the hospice visits, nursing care, counseling, or medical equipment itself. You do pay a copay of up to $5 per prescription for drugs related to your terminal illness, and up to $5 per day for respite care — a short hospital or facility stay that gives your family a break from caregiving at home. These are the only costs Medicare requires you to pay.

The hospice agency itself bills Medicare directly for the services. Medicare pays the agency a fixed daily rate that covers all the medical care, not a per-visit fee. This means the hospice has no financial incentive to send more nurses or doctors than you need, and you do not face surprise bills if your care plan changes.

If you have a Medigap or Medicare Advantage plan, that plan may cover some or all of your copays. Check your plan documents or call the plan to ask what hospice copays it covers before you enroll in hospice.

Key Takeaways

  • Medicare Part A covers hospice care with no charge for visits, nursing, or equipment — you pay only small copays for drugs and respite care.
  • You must have a doctor's written statement that you have six months or less to live, and you must choose a Medicare-approved hospice agency.
  • Copays are capped at $5 per prescription for terminal-illness medications and $5 per day for respite care, with no limit on the number of days.
  • If you have Medigap or Medicare Advantage, your plan may cover these copays — contact your plan to confirm before enrolling in hospice.
  • Costs for non-medical services like housekeeping or spiritual counseling are covered by Medicare and do not require a copay.

What Medicare Part A covers in hospice

Medicare Part A pays for doctor visits, nursing care, home health aide services, social work, chaplain or spiritual counseling, and bereavement counseling for your family after you die. It also covers medical equipment like oxygen, wheelchairs, walkers, and hospital beds, as well as medications for pain and symptom management. Physical therapy, occupational therapy, and speech therapy are covered if they help manage your symptoms rather than cure your illness.

Meals, housekeeping, and laundry services are covered as part of the hospice benefit. So is inpatient respite care — a short stay in a hospital or facility so your family can rest. You pay $5 per day for respite care, up to five consecutive days at a time, but there is no limit on how many times you can use it during your hospice stay.

The hospice agency coordinates all these services. You do not need separate referrals or approvals for each one. Once you enroll, the agency's care team works with your doctor to create a plan that addresses your medical and personal needs.

Medications and equipment copays

You pay $5 per prescription for any medication related to your terminal illness — pain relievers, anti-nausea drugs, anxiety medication, or anything else your hospice doctor prescribes to manage your condition. This copay applies whether the medication is delivered to your home or you pick it up from a pharmacy. If you take the same medication for months, you pay $5 each time you refill it.

Medical equipment — oxygen tanks, hospital beds, commodes, walkers — has no copay. Medicare covers the full cost of rental or purchase through the hospice agency. If you need equipment that is not related to your terminal illness, that equipment is not covered by the hospice benefit and you would pay out of pocket or through another part of Medicare.

Some hospice agencies include certain over-the-counter items like incontinence supplies or comfort items as part of their service at no charge. Ask your hospice team what is included before you purchase anything yourself.

When you stop paying for other Medicare services

Once you enroll in hospice, you stop paying copays and coinsurance for any services related to your terminal illness. This includes doctor visits, hospital stays, and emergency room visits — as long as they relate to the condition you are receiving hospice for. Medicare Part A covers these visits at no cost to you.

However, if you need treatment for a condition that is not related to your terminal illness, you may still owe copays under the regular Medicare rules. For example, if you are in hospice for cancer but break your arm, the emergency room visit and X-rays for the broken arm might not be covered by hospice. Ask your hospice doctor and your Medicare plan whether a specific service is covered under hospice or under regular Medicare.

You continue to pay your Medicare Part B premium while you are in hospice, even though Part B does not cover most hospice services. If you want to stop paying the premium, you can disenroll from Part B, but you should discuss this with your hospice team first because it may affect other coverage.

Costs if you choose an out-of-network hospice

Medicare requires you to use a Medicare-approved hospice agency. If you choose an agency that is not approved by Medicare, Medicare will not pay for the care and you will owe the full cost yourself — often $200 to $300 per day or more, depending on the level of care.

To check whether a hospice is Medicare-approved, use the Medicare Care Compare tool on Medicare.gov or call 1-800-MEDICARE. Your doctor can also tell you which agencies in your area accept Medicare. Most hospice agencies are Medicare-approved because that is where the majority of their patients come from.

If a hospice agency tells you it is not Medicare-approved but offers better services or a different philosophy of care, ask whether it plans to become approved. Some smaller or newer agencies are in the process of certification. In the meantime, you would pay out of pocket.

How to enroll and what happens to your costs

To start hospice, your doctor must sign a statement saying you have a prognosis of six months or less to live. This does not mean you will die in exactly six months — some people live longer, some shorter. It means your doctor believes your illness is advanced enough that curative treatment is no longer the goal.

You then choose a Medicare-approved hospice agency. The agency handles all the paperwork with Medicare. On the day you enroll, your hospice copays begin and your regular Medicare copays for related services end. If you are hospitalized and then move to hospice, the transition happens on your enrollment date.

If you later decide hospice is not right for you, you can disenroll at any time. If you disenroll and then want to re-enroll later, you can do that too. Each time you enroll, the six-month clock restarts — Medicare will cover hospice for another six months if your doctor recertifies that you still have six months or less to live.

Medigap and Medicare Advantage coverage of hospice costs

Medigap plans (supplemental insurance) vary in what they cover. Some Medigap plans cover the $5 copays for medications and respite care; others do not. Check your plan's Summary of Benefits or call the plan to ask specifically about hospice copays before you enroll in hospice.

Medicare Advantage plans must cover hospice at the same level as Original Medicare — meaning the same copays explore. However, some Advantage plans may cover the copays as an extra benefit. Call your Advantage plan and ask whether it covers hospice copays before you enroll.

If you do not have Medigap or Advantage coverage, the $5 copays are your only out-of-pocket costs for hospice services covered by Medicare. This is one of the most affordable benefits Medicare offers.

Frequently Asked Questions

Do I have to pay anything upfront when I enroll in hospice?

No. The hospice agency bills Medicare directly, and Medicare pays the agency. You do not pay an enrollment fee or deposit. You only pay copays as you use services — $5 per prescription and $5 per day for respite care if you use it.

What if I live longer than six months?

Medicare will continue to cover your hospice care. Your doctor recertifies every 60 days that you still have a terminal illness. As long as your doctor certifies you, Medicare pays. There is no time limit on how long you can receive hospice, only the requirement that your doctor believes you have six months or less to live at each recertification.

Does Medicare cover hospice in a nursing home or assisted living?

Yes. Medicare covers hospice services wherever you live — at home, in a nursing home, assisted living facility, or hospital. The hospice agency sends staff to you. If you are already in a facility, the facility's staff and the hospice staff work together on your care plan.

Can I switch hospice agencies if I am not satisfied?

Yes. You can change to a different Medicare-approved hospice agency at any time. Tell your current agency you want to disenroll, then enroll with the new agency. There is no penalty or waiting period. Your new agency will coordinate the transfer of your medical records.

What happens to my hospice coverage if I move to a different state?

Your Medicare hospice benefit travels with you. Find a Medicare-approved hospice in your new state and enroll. Your doctor's prognosis and medical history transfer to the new agency. The copays and coverage remain the same.