For most people in the United States, hospice care is fully covered by Medicare, Medicaid, or private insurance, with little to no out-of-pocket cost. The majority of hospice patients pay nothing beyond small copays for prescription drugs and occasional respite stays. If you’re uninsured or paying privately, many hospice providers offer sliding-scale fees based on what your family can afford.
The real cost picture depends on your insurance, where care is provided, and whether you need services that fall outside the hospice benefit. Here’s how it breaks down.
What Medicare Covers (and What It Doesn’t)
Medicare Part A covers hospice care for anyone with a terminal illness and a life expectancy of six months or less, as certified by a doctor. Once you elect the hospice benefit, Medicare pays for nursing visits, medical social services, counseling, medications related to your terminal diagnosis, medical equipment, and short-term inpatient care when symptoms can’t be managed at home. You can receive these services in your own home, an assisted living facility, or a nursing home.
The two areas where you will pay something out of pocket are prescription drugs and respite care. Medicare requires a small copay (no more than $5 per prescription) for outpatient drugs used for pain management and symptom control. For inpatient respite care, which gives your caregiver a temporary break, you pay 5% of the Medicare-approved amount for each stay of up to five consecutive days.
The biggest gap in Medicare’s hospice benefit is room and board. If you live in a nursing home or assisted living facility and elect hospice, Medicare does not cover the cost of your room and meals. That expense, which can run several thousand dollars per month depending on your location and facility, remains your responsibility or must be covered by Medicaid or another source. For patients receiving hospice at home, room and board obviously isn’t a factor.
Equipment and Supplies at No Cost
One of the most valuable parts of the hospice benefit is that medical equipment and supplies arrive at no charge. The hospice provider arranges delivery and setup of whatever you need: hospital beds, bed rails, mattresses, oxygen systems and masks, wheelchairs (manual or motorized), and bedpans. Medications, bandages, and other supplies related to the terminal condition are also included. You don’t need to shop for or rent any of this separately. The hospice team manages it all.
How Medicaid Handles Hospice
Medicaid covers hospice as an optional benefit, and most states have chosen to include it in their plans. The services mirror what Medicare provides: nursing, physician visits, counseling, therapies, medical equipment, home health aides, and short-term inpatient care. Reimbursement rates follow the same structure Medicare uses, updated annually.
To receive hospice through Medicaid, you file an election statement with a hospice provider and acknowledge that you’re waiving Medicaid coverage for curative treatments of the terminal condition. You can revoke that election at any time and return to standard Medicaid benefits if you change your mind. One important exception: children and young adults under 21 on Medicaid or CHIP can receive both curative treatment and hospice care simultaneously, thanks to a provision in the Affordable Care Act. They don’t have to choose one or the other.
For people who qualify for both Medicare and Medicaid (known as dual eligibles), Medicaid often picks up costs that Medicare doesn’t cover, including nursing home room and board. This combination can eliminate out-of-pocket costs entirely.
Private Insurance and Other Payers
Most private health insurance plans include some level of hospice coverage, though the specifics vary widely. Some plans cover hospice comprehensively, while others use cost-sharing arrangements that leave you responsible for a percentage. Long-term care insurance policies frequently cover hospice as well, but the scope depends on when the policy was written and what it includes. Check your plan documents or call your insurer to find out exactly what’s covered before making a decision.
TRICARE, the military health system, provides a hospice benefit to beneficiaries with life-limiting conditions. It can cover nursing, social work, therapies, personal care, medications, and medical equipment. Managed care organizations that contract with Medicare must provide the full range of Medicare-covered hospice services.
Veterans may also access hospice through VA healthcare, which provides end-of-life services either in VA facilities or through community partnerships. If you or a family member is a veteran, contacting the local VA medical center is worth doing early in the planning process.
Medicare Advantage and Hospice
This is an area that catches people off guard. If you’re enrolled in a Medicare Advantage plan and elect hospice, your hospice care is paid for by Original Medicare (Part A), not your Advantage plan. You essentially step outside your Advantage plan for hospice-related services. Your Advantage plan continues to cover any medical needs unrelated to your terminal diagnosis.
CMS ran a pilot program starting in 2021 that allowed some Medicare Advantage plans to include the hospice benefit directly, aiming to reduce the fragmentation of switching between two systems. That program is ending as of December 31, 2024, due to limited participation and operational challenges. Going forward, the standard rule applies: hospice goes through Original Medicare regardless of your Advantage plan.
Paying Without Insurance
If you or a family member has no insurance coverage, hospice care is still accessible. Many hospice organizations are nonprofit and have charitable care programs or community funding specifically for uninsured patients. Sliding-scale payment options are common, meaning the provider adjusts the cost based on your household income and financial situation. Some families pay nothing at all through these programs.
For those who do pay out of pocket at full price, costs vary by provider and region but can range from roughly $150 to $300 or more per day for routine home hospice care. Inpatient hospice or continuous care for a symptom crisis costs significantly more. Before assuming you’ll need to pay privately, it’s worth exploring whether you qualify for Medicaid, which has income thresholds that vary by state and may be more generous than you expect, particularly for people with high medical expenses.
What Hospice Does Not Cover
Regardless of your insurance, hospice care has boundaries. Once you elect the hospice benefit, your coverage shifts to comfort-focused care. Treatments aimed at curing the terminal illness, such as chemotherapy intended to eliminate cancer rather than manage pain, are no longer covered under the hospice benefit. Emergency room visits and hospitalizations related to the terminal diagnosis are also generally not covered unless arranged through your hospice team.
You can still receive full insurance coverage for any medical conditions unrelated to your terminal diagnosis. If you break your arm or need treatment for diabetes while on hospice, that care is billed to your regular insurance as usual. And if you decide hospice isn’t right for you, you can revoke the benefit at any time and return to standard curative coverage. The choice is never permanent.