For most families, Medicare pays for hospice care at home. If your loved one has Medicare Part A and qualifies for hospice, the Medicare hospice benefit covers the hospice team, the visits, the medical equipment, the supplies, and the drugs for pain and symptom control. There is no deductible. What you usually pay is small: up to $5 per prescription for those drugs and 5% of the Medicare-approved amount if your loved one has a short inpatient respite stay.
If your loved one does not have Medicare, hospice care at home is often paid by Medicaid, the VA, or private health insurance. What none of these usually pay for is round-the-clock private caregivers or room and board. That part often falls to the family, and it is the part that surprises people most.
Who pays for hospice care at home, at a glance
- Medicare: pays for most hospice care in the United States, through the Medicare hospice benefit under Part A.
- Medicaid: covers hospice in most states, and can also help with some costs Medicare does not cover.
- The VA: covers hospice for enrolled veterans who need it, with no copay.
- Private health insurance: many employer and marketplace plans include hospice coverage, with their own rules.
- You and your family: pay for things outside the benefit, such as extra caregiving hours, rent, food, and anything not in the care plan.
How the Medicare hospice benefit works
Hospice care is care for someone whose illness can no longer be cured, or who has decided to stop treatment meant to cure it. The goal is comfort. The hospice care team manages pain and other symptoms, and supports the whole family through end-of-life care. Most people receive hospice care at home, whether that home is a house, an apartment, or a family member’s spare room.
Once your loved one signs up, Original Medicare pays the hospice provider directly. The hospice then provides or arranges everything related to the terminal illness. You do not get a stack of separate bills from nurses, aides, and equipment companies. For a closer look at what the visits feel like day to day, see what hospice at home looks like.
Who is eligible for hospice care at home under Medicare
Your loved one can get the Medicare hospice benefit if they have Medicare Part A and meet all three of these conditions:
- The hospice doctor and their regular doctor, if they have one, certify that they are terminally ill, with a life expectancy of six months or less if the illness runs its normal course.
- They accept comfort care, also called palliative care, instead of care to cure the illness.
- They sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
Before signing up, your loved one can have a one-time consultation with a hospice medical director or hospice doctor to talk about care options and pain control, even if they decide not to use hospice. Hospice is not only for cancer. People with heart failure, lung disease, dementia, kidney failure, and many other illnesses receive hospice care. If the decision itself feels heavy right now, our guide to coming to terms with hospice care may help.
How long Medicare will pay for hospice at home
There is no fixed end date. Medicare pays for hospice in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. At the start of each new period after the first, a hospice doctor has to recertify that your loved one is still terminally ill. If someone lives longer than six months, hospice care can continue as long as the doctor keeps recertifying.
Your loved one can also leave hospice at any time, for example to try a new treatment, and come back later if they are still eligible. They can change hospice providers once in each benefit period.
What Medicare covers in hospice care
Depending on the care plan, the Medicare hospice benefit covers:
- Doctor services and nursing care
- Hospice aide and homemaker services, such as help with bathing (a hospice aide does much of the same work as a home health aide)
- Medical equipment, such as a hospital bed, wheelchair, walker, or oxygen
- Medical supplies, such as bandages and catheters
- Prescription drugs for pain and symptom control
- Physical, occupational, and speech therapy
- Social worker services, dietary counseling, and spiritual support
- Grief and loss counseling for the family
- Short-term inpatient care when pain or symptoms cannot be managed at home
- Short-term inpatient respite care so the family caregiver can rest
A hospice nurse and doctor are on call 24 hours a day, 7 days a week. In a medical crisis, the hospice can also provide continuous home care, with a nurse staying for longer stretches until symptoms are under control.
What you pay for hospice care at home with Medicare
With Original Medicare and a Medicare-approved hospice provider, the out-of-pocket cost of hospice care is low:
- $0 for hospice services
- Up to $5 per prescription for outpatient drugs for pain and symptom management
- 5% of the Medicare-approved amount for inpatient respite care
- Your usual monthly Medicare Part A and Part B premiums
If your loved one has a Medigap policy, it helps cover the drug copays and the respite coinsurance. You can check the current rules on the Medicare hospice care page.
What hospice does not pay for
This is where families often get caught off guard. The Medicare hospice benefit does not cover:
- Treatment to cure the terminal illness. Care for other, unrelated health problems is still covered by regular Medicare, with the usual deductibles and copays.
- Room and board. Hospice does not pay rent, food, or utilities at home, or the daily room charge in a nursing home or assisted living. The exception is a short inpatient or respite stay that the hospice arranges.
- 24-hour private caregivers. Hospice care at home is built around visits, not someone living in. Family members usually provide most of the hands-on care between visits. We explain this in detail in does hospice cover 24-hour care.
- Care the hospice did not arrange. If you call 911 and your loved one goes to the emergency room for the terminal illness without the hospice setting it up, you may owe the full cost. Call the hospice first, any time of day.
- Drugs not related to the terminal illness. These may still be covered by a Part D plan with its usual copays.
How much is hospice care at home without insurance
Medicare pays hospice providers a set daily rate for each level of care. The national base rate for routine home care is about $236 per day for the first 60 days and about $186 per day after that, before it is adjusted for local wages. Continuous home care during a crisis, inpatient respite care, and general inpatient care are paid at higher daily rates. These figures come from the Centers for Medicare and Medicaid Services hospice payment rule, which is updated each year.
Those numbers give you a sense of the real cost of hospice care. They are not a price list for private patients. If you are paying privately, ask each hospice provider for its private-pay rate in writing, and ask whether it offers charity care or a sliding scale. Some hospices do, especially nonprofit ones.
Does Medicaid pay for hospice at home?
In most states, yes. Hospice is an optional Medicaid benefit, which means each state decides whether to offer it, and most states do. The rules look a lot like Medicare’s: a terminal illness, a doctor’s certification, and a signed choice of comfort care over curative treatment.
If your loved one has both Medicare and Medicaid, Medicare pays for the hospice care first. Medicaid can then help with other costs, such as room and board in nursing facilities for someone who lives there. Some states also have home and community-based waiver programs that pay for extra in-home help. Call your state Medicaid office or ask the hospice social worker what is available where you live.
Does the VA pay for hospice care at home?
Yes, for veterans enrolled in VA health care who need it. Hospice is part of the VA’s standard medical benefits package, and there are no copays for hospice, whether the VA provides it or a community hospice under contract with the VA. The VA hospice care page explains how to ask for a referral.
Private insurance and Medicare Advantage
Many private health insurance plans cover hospice care, but the details vary. Some cover the same services as Medicare, others limit the number of days or require you to use in-network hospice agencies. Call the number on the insurance card and ask for the hospice benefit in writing.
If your loved one is enrolled in a Medicare Advantage plan, hospice works a little differently than you might expect. Once hospice starts, Original Medicare pays for the hospice care, not the Advantage plan. Your loved one can stay in the plan as long as they keep paying its premiums, and the plan keeps covering extra benefits and care for problems not related to the terminal illness. The plan must also help you find a Medicare-approved hospice in your area.
Paying for the gaps around hospice care
Even when in-home hospice is fully covered, your loved one’s care needs may be bigger than the visits, and many families spend money on the things around it. The most common costs are:
- Extra caregiving hours from a private home care agency, often so a family member can work or sleep
- Rent or care fees in assisted living or a nursing home
- Comfort items the hospice does not supply
- Time away from work for family caregivers
Long-term care insurance, if your loved one has it, may pay for some of these hours at home. If you need help paying for hospice extras, the hospice social worker can help you look for local grants, volunteer programs, and waiver programs. If you are already stretched thin, read our guide for family caregivers, and do not wait until you are exhausted to ask for respite.
Questions to ask a hospice provider about cost
When you talk with a hospice provider, bring this list. You can find more questions in our guide to interviewing home care or hospice providers.
- Are you Medicare-approved, and do you accept Medicaid and our insurance?
- Is there anything in our situation that Medicare or our insurance will not cover?
- Which drugs, equipment, and supplies will you provide, and which will we have to buy?
- How often will the nurse and the aide visit, and who do we call at night?
- If symptoms get worse, can you provide continuous home care or a short inpatient stay?
- How do we arrange respite care, and what will it cost us?
- Do you offer charity care or a sliding scale for families paying privately?
- Can your social worker help us find Medicaid, VA, or local programs for extra help at home?
