Who pays for hospice care in a nursing home?
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Key takeaways
- Medicare pays the hospice for hospice care. There is no deductible, and you pay nothing for covered hospice services from a Medicare-approved hospice.
- Medicare does not cover room and board in a nursing home. You pay it, or Medicaid does if you qualify.
- You may owe up to $5 for each prescription for pain and symptom management.
- Hospice is not limited to six months. It continues as long as a hospice doctor recertifies that you are terminally ill, and you can stop it at any time.
Medicare pays for hospice care, but it does not pay for room and board in a nursing home. When a resident chooses hospice, the hospice bills Medicare for the hospice care. Room and board is not part of that: the resident pays it, or Medicaid does for a resident who qualifies. If Medicare was covering a short skilled nursing stay, see the section on skilled care below.
Who pays for what?
| Cost | Who pays under Original Medicare |
|---|---|
| Hospice care for the terminal illness | Medicare Part A pays the hospice. There is no deductible, and you pay nothing for covered services from a Medicare-approved hospice. |
| Drugs for pain and symptom management | You pay a copayment of up to $5 for each prescription. |
| Room and board in the nursing home | Not covered by Medicare. You pay, or Medicaid does if you qualify for Medicaid nursing home coverage. |
| Care for health problems unrelated to the terminal illness | Original Medicare pays as usual, and you owe the usual deductibles and coinsurance. |
Medicare.gov puts it this way: "Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility." The exception is a short-term inpatient stay that the hospice team arranges.
Who qualifies for Medicare hospice?
- You have Medicare Part A.
- A hospice doctor, and your regular doctor if you have one, certify that you are terminally ill, meaning a life expectancy of 6 months or less if the illness runs its normal course.
- You accept comfort care instead of care to cure the illness, and sign a statement choosing hospice.
- The hospice is approved by Medicare.
Hospice is not limited to six months. Medicare covers two 90-day benefit periods and then an unlimited number of 60-day periods, as long as a hospice doctor recertifies that you are terminally ill. You can change your hospice once in each benefit period, and you can stop hospice at any time in writing and return to regular Medicare coverage.
What does the hospice do, and what does the nursing home keep doing?
| Topic | Hospice | Nursing home |
|---|---|---|
| Main job | Manages care for the terminal illness: medical direction, nursing, counseling and social work | Room and board around the clock, personal care and nursing needs, coordinated with the hospice |
| Supplies and drugs | Medical supplies, equipment and drugs for pain and symptoms of the terminal illness | Its usual services. CMS guidance says residents on hospice must be offered the same services as other residents. |
| Changes in condition | Decides the course of hospice care, including changes in the level of service | Tells the hospice immediately about a significant change |
Federal rules require the resident's nursing home care plan to include the most recent hospice plan of care, and each side names a person responsible for coordinating with the other. A nursing home may not charge a resident for hospice services that Medicare or Medicaid pays for.
What if Medicaid pays for the nursing home?
When a nursing home resident who qualifies for Medicaid nursing home coverage chooses hospice, federal law requires the state to pay an amount for room and board equal to at least 95 percent of what it would have paid the home. The state pays that amount to the hospice, and the hospice passes it on to the nursing home. Medicaid.gov describes the payment as reduced by the amount the resident is able to contribute to the cost of care, so a resident's share of cost continues. See how Medicaid pays for a nursing home.
Does the nursing home have to allow hospice?
Not in the building. Federal rules let a nursing home either arrange hospice through a written agreement with one or more Medicare-certified hospices, or not arrange it and help a resident who asks to transfer to a facility that will. A written agreement between the home and the hospice must be in place before hospice care is given there.
You choose your hospice. CMS guidance says that if the home has agreements with more than one hospice, it must tell you so that you can choose. If the hospice you want has no agreement with the home, the home may sign one, or it must help you transfer if you ask.
Can you have hospice and Medicare-covered skilled nursing care together?
Only when the skilled nursing stay is for a condition unrelated to the terminal illness. Choosing hospice waives Medicare payment for other care related to the terminal illness, apart from care provided or arranged by the hospice and by your attending doctor. See what Medicare covers in a nursing home.
What if you have a Medicare Advantage plan?
Original Medicare pays for hospice even if you stay in your plan. Medicare.gov says the plan can still cover services that are not part of the terminal illness, and its extra benefits continue as long as you keep paying the plan's premiums and other costs. If you leave hospice, the plan's coverage starts again on the first day of the following month.
What should the hospice tell you up front?
For hospice elections that begin on or after October 1, 2026, federal rules require the hospice to give you a written list of the conditions, items, services and drugs it has determined are unrelated to your terminal illness and will not cover. It is due within 5 days of the date your hospice election takes effect. Medicare.gov advises contacting your hospice team before you get care outside the hospice, "or you might have to pay the entire cost."
To look up a hospice's record from CMS, including family caregiver survey ratings, see find a hospice.