For most Americans, in-home hospice care costs little to nothing out of pocket. Medicare, Medicaid, and most private insurers cover hospice services for patients with a terminal illness and a life expectancy of six months or less. If you have Medicare Part A, your only regular expense is a copay of up to $5 per prescription for pain and symptom medications. The full picture gets more complicated when you factor in supplemental caregiving, room and board, and gaps in coverage, so here’s what to expect.
What Medicare Covers (and What You Pay)
Medicare Part A covers the vast majority of in-home hospice costs once a doctor certifies that a patient is terminally ill. This includes nurse visits, aide services, medical social work, counseling, medical equipment like hospital beds and oxygen concentrators, and supplies related to the terminal diagnosis. The hospice agency bills Medicare directly for all of this.
Your out-of-pocket costs under Medicare are minimal. You pay up to $5 per prescription for outpatient drugs used for pain and symptom management. If you need inpatient respite care (a short stay at a facility so your family caregiver can rest), you pay 5% of the Medicare-approved amount for that stay. Your total respite copay can’t exceed the annual inpatient hospital deductible. Beyond those two items, Medicare-covered hospice services come at no cost to the patient.
One important detail: the hospice agency takes over responsibility for all durable medical equipment, prosthetics, orthotics, and supplies related to the terminal illness. Even if you were already renting a hospital bed or buying supplies through Medicare Part B before enrolling in hospice, the hospice program absorbs those costs. Medicare Part B only continues covering items prescribed for a completely unrelated condition.
What Hospice Does Not Cover
The biggest cost surprise for families is that hospice does not provide round-the-clock home care. Hospice nurses and aides visit on a scheduled basis, typically a few times per week, with additional visits as symptoms change. Between those visits, the family or other caregivers are responsible for day-to-day care. If your loved one needs someone in the home 8, 12, or 24 hours a day, that continuous personal care falls outside what hospice provides under normal circumstances.
Hospice also does not cover room and board. If a patient lives in an assisted living facility or nursing home, the cost of that room continues as a separate expense. Hospice pays for the medical care delivered there, not the housing itself.
Treatments aimed at curing the terminal illness are excluded as well. When a patient elects hospice, they’re choosing comfort-focused care. Any procedures, medications, or therapies intended to cure (rather than manage symptoms of) the primary diagnosis are not covered under the hospice benefit.
The Real Cost: Supplemental Caregiving
For many families, the largest expense during hospice isn’t a medical bill. It’s the cost of hiring extra help at home. When a patient can no longer be left alone safely but family members work full-time or live far away, the gap between scheduled hospice visits needs to be filled by a private caregiver.
The national median cost for nonmedical in-home care is about $33 per hour in 2025. At that rate, hiring a home health aide for 8 hours a day runs roughly $264 per day, or nearly $8,000 per month. Twenty-four-hour care can exceed $16,000 to $20,000 monthly. These costs are entirely out of pocket unless you have long-term care insurance or qualify for specific state programs. This supplemental caregiving is often the single biggest financial burden families face during a hospice stay at home.
Medicaid and Private Insurance
Medicaid covers hospice in most states, though it’s classified as an optional benefit, meaning the specifics vary by state. In states that offer it, Medicaid generally mirrors Medicare’s hospice benefit and covers nursing, aide visits, medications, and equipment with little or no cost to the patient. If you’re dually eligible for both Medicare and Medicaid, Medicare serves as the primary payer for hospice while Medicaid may pick up remaining costs.
Most private health insurance plans also include a hospice benefit modeled on Medicare’s structure. Coverage details, including deductibles and coinsurance, depend on your specific plan. Some plans may require prior authorization or have network restrictions on which hospice agencies you can use. Reviewing your policy’s hospice section or calling the insurer directly is the fastest way to confirm your costs.
If You’re Uninsured
People without any insurance coverage still have options. Many hospice providers in the United States are nonprofit organizations, and most of them maintain charity care funds specifically for uninsured patients. Capital Caring Health, one of the larger nonprofit hospice providers on the East Coast, distributes more than $3 million in charity care to uninsured patients annually through its Patient Care Fund, funded by public donations. This model is common across the nonprofit hospice sector.
If you’re uninsured, contact hospice agencies in your area and ask about financial assistance, sliding-scale fees, or charity care programs. The National Hospice and Palliative Care Organization can help you locate providers. Many agencies will not turn patients away based on inability to pay.
How to Estimate Your Total Costs
To get a realistic picture of what in-home hospice will cost your family, separate the medical side from the caregiving side. On the medical side, if you have Medicare or equivalent coverage, budget for minimal prescription copays and not much else. On the caregiving side, assess honestly how many hours per day your loved one will need someone present, and whether family members can cover those hours or whether you’ll need to hire help.
A few factors that affect the caregiving equation: patients with dementia or confusion often need supervision around the clock earlier in the process, while patients who are still mobile and mentally clear may need less hands-on help initially. Symptoms tend to increase in the final weeks, so families who managed early on sometimes need to bring in paid help closer to the end. Planning for that shift in advance, even roughly, helps avoid financial strain during an already difficult time.