For most people, home hospice care is free or nearly free. Medicare, Medicaid, and VA benefits all cover hospice at home with no cost to the patient, and most private insurance plans include hospice coverage as well. The real out-of-pocket expenses families face typically come not from the hospice benefit itself, but from supplemental caregiving that hospice doesn’t provide.
What Medicare Covers (and What It Doesn’t)
Medicare Part A covers 100% of hospice care with no copayments, no deductibles, and no coinsurance, as long as you use a Medicare-approved hospice provider. This includes nursing visits, medical equipment like hospital beds and oxygen, medications related to your terminal illness, social work services, chaplain visits, and bereavement support for your family. About 90% of hospice patients in the U.S. are on Medicare, so this is the coverage most families will use.
There are two small exceptions. You may owe a copayment of no more than $5 for each prescription drug related to pain management or symptom control. And if you use inpatient respite care (short stays at a facility so your family caregiver can rest), there’s a small coinsurance for each day.
What Medicare’s hospice benefit explicitly does not cover:
- Room and board. You’re responsible for your own housing costs, though short-term inpatient stays arranged by the hospice team are covered.
- Curative treatment. Once you elect hospice, Medicare stops covering treatments aimed at curing the terminal illness. You can still receive care for unrelated conditions.
- Medications unrelated to your terminal diagnosis. These may still be covered under Medicare Part D.
- Care not arranged by your hospice team. Emergency room visits, hospital stays, or ambulance rides must be coordinated through your hospice provider to be covered.
- Housekeeping, cooking, or around-the-clock home aides. Hospice provides intermittent visits, not 24-hour caregiving.
Medicaid, VA, and Private Insurance
Medicaid covers hospice in most states as an optional benefit. A physician must certify that the patient is terminally ill, and the patient elects the hospice benefit by signing an election statement. When you elect hospice through Medicaid, you generally waive coverage for curative treatment of the terminal illness, though you can revoke that election at any time and return to standard Medicaid benefits. One important exception: patients under 21 can receive both curative treatment and hospice care simultaneously.
Veterans enrolled in VA healthcare receive hospice care at no cost. There are no copays for hospice whether it’s provided directly by the VA or through a community hospice agency under VA contract. The VA works closely with local home hospice agencies to deliver care in the veteran’s home.
Private insurers generally cover hospice, but the specifics vary by plan. Some mirror Medicare’s structure with little to no cost-sharing, while others may require deductibles or coinsurance. Contact your insurer before electing hospice to confirm what’s covered and what you’ll owe.
The Costs Families Actually Pay
The biggest expense most families encounter isn’t hospice itself. It’s the gap between what hospice provides and what the patient actually needs day to day. Hospice sends a nurse a few times a week, a home health aide for a few hours on scheduled days, and on-call support for emergencies. It does not provide a full-time caregiver. Someone still needs to help with meals, bathing, toileting, repositioning, and medication reminders during all the hours between hospice visits.
For families who can’t provide that care themselves, hiring a private-duty caregiver is the main out-of-pocket cost. The national average rate for a hospice caregiver runs about $15 per hour, with most earning between $13 and $17 per hour depending on location and experience. If you need 8 hours of daily help, that works out to roughly $120 a day or $3,600 a month. Round-the-clock care (two or three shifts of caregivers) can reach $10,000 to $15,000 monthly, making it by far the largest expense families face during home hospice.
Other costs that add up include incontinence supplies beyond what hospice provides, extra bedding, nutritional supplements, and home modifications like grab bars or a ramp. None of these are covered by the hospice benefit.
Options If You’re Uninsured
If you don’t have Medicare, Medicaid, VA benefits, or private insurance, hospice care is still accessible. Most hospice agencies in the U.S. are nonprofit organizations, and many offer charity care or sliding-scale fees based on income. Federal tax law requires nonprofit hospitals and health systems to maintain financial assistance policies, make them publicly available, and notify patients about them during intake. Ask the hospice provider directly about financial assistance before assuming you’ll face the full cost.
Some hospice organizations are funded partly through community donations specifically to serve uninsured patients. The Hospice Foundation of America and local United Way chapters can help connect families with these resources. Many hospice agencies will tell you upfront that they do not turn patients away for inability to pay.
How to Estimate Your Total Cost
Start by identifying your insurance coverage, since that determines whether the hospice benefit itself costs you anything. Then assess how many hours of private caregiving your family will need beyond what hospice provides. That caregiving gap is where the real budget planning matters.
A family where one person can serve as the primary caregiver, with hospice supplementing through scheduled visits, may spend very little out of pocket. A family that needs to hire full-time help could spend $3,000 to $15,000 a month depending on hours and location. The average hospice stay in the U.S. is under 90 days, so even at higher caregiving rates, the total cost is often less than a single month in a skilled nursing facility.