Who Pays for Hospice Care at Home? Medicare, Medicaid, VA and What Families Still Cover

For most families, Medicare pays for hospice care at home. If your loved one has Medicare Part A, a doctor certifies a life expectancy of six months or less, and they choose comfort care instead of curative treatment, the Medicare hospice benefit covers the hospice team, medications for symptoms, medical equipment and supplies with little or no cost to the patient. Medicaid, the VA and most private insurance plans also cover hospice. What none of them pay for is round-the-clock caregiving at home (except during short crises) or rent and meals in a facility, so families usually supply or hire the day-to-day hands-on help.

This guide explains what home hospice actually includes, how the Medicare benefit works in 2026, the four levels of hospice care, what other payers cover, and the costs families should plan for.

What is hospice care at home?

Hospice care at home is medical, emotional and spiritual care for someone with a terminal illness, delivered wherever they live: their own house, a relative’s home, an assisted living apartment or a nursing home. The goal shifts from curing the illness to keeping the person comfortable, controlling pain and other symptoms, and supporting the family.

A hospice agency assigns an interdisciplinary team that builds a plan of care around the patient’s wishes. That team typically includes:

• A hospice physician (working with the patient’s own doctor, if they want) who oversees the plan
• Registered nurses who visit regularly, manage pain and symptoms, and teach family caregivers
• Hospice aides who help with bathing, grooming and personal care during scheduled visits
• A medical social worker who helps with planning, paperwork and family concerns
• A chaplain or spiritual counselor, if wanted
• Trained volunteers who can sit with the patient or run errands
• Bereavement counselors who support the family after the death

The key point most families miss: hospice is a visiting service. The team comes in, provides care and leaves. A nurse is on call 24 hours a day by phone and can come out for urgent problems, but hospice staff do not normally stay in the home around the clock.

The Medicare hospice benefit: who qualifies

Medicare is the largest payer of hospice in the US, and its rules set the template that Medicaid and many private plans follow. To use the Medicare hospice benefit, a person must meet all of these conditions:

Requirement	What it means in practice
Has Medicare Part A	Most people 65 and older have Part A automatically.
Terminal illness certified	The hospice doctor and the patient’s regular doctor (if they have one) certify that life expectancy is six months or less if the illness runs its normal course.
Chooses comfort care	The patient accepts palliative care instead of treatment meant to cure the terminal illness.
Signs an election statement	A Hospice Election Statement chooses hospice care from a specific Medicare-approved hospice.

Source: Medicare.gov, Hospice care coverage.

A six-month prognosis is a medical estimate, not a deadline. People who live longer can keep receiving hospice as long as a doctor continues to certify that they are terminally ill. Some people also improve enough to leave hospice, and they can return later if their condition declines.

Benefit periods and recertification

Medicare hospice is organized into benefit periods:

• First period: 90 days
• Second period: 90 days
• After that: an unlimited number of 60-day periods

At the start of each period, the hospice doctor must recertify that the patient is still terminally ill. Starting with the third benefit period (around the six-month mark), a hospice physician or hospice nurse practitioner must also have a face-to-face visit with the patient no more than 30 days before each recertification. Patients can change hospice agencies once per benefit period, and they can stop hospice at any time to resume curative treatment.

What Medicare hospice covers at home

Once someone elects hospice, Medicare pays the hospice agency a daily rate, and the agency is responsible for everything related to the terminal illness. Covered services include:

• Doctor and nurse visits
• Hospice aide and homemaker services
• Medical equipment such as a hospital bed, wheelchair, walker or oxygen
• Medical supplies such as bandages, catheters and incontinence supplies
• Prescription drugs for pain relief and symptom control
• Physical, occupational and speech therapy when they help comfort
• Dietary counseling
• Social work services and spiritual counseling
• Grief and loss counseling for the patient and family
• Short-term inpatient care for symptoms that cannot be managed at home
• Short-term inpatient respite care so family caregivers can rest

Health problems unrelated to the terminal diagnosis are still covered by Original Medicare (or a Medicare Advantage plan) with the usual deductibles and coinsurance. For example, a hospice patient with cancer who breaks a wrist is still covered for the fracture.

The 4 levels of hospice care

Federal rules define four levels of hospice care. Every Medicare-certified hospice must be able to provide all four, and the level can change from day to day based on what the patient needs.

Level of care	Where it happens	When it is used	Key limits
Routine home care	Wherever the patient lives	Most hospice days. Scheduled visits from nurses, aides and other team members, plus 24/7 on-call support.	Visits only, not around-the-clock staff.
Continuous home care	At home	Brief periods of crisis, such as uncontrolled pain or severe breathing distress, so the patient can stay home.	Must be mostly nursing care, at least 8 hours in a 24-hour day, only during a crisis.
Inpatient respite care	Medicare-approved facility (hospice unit, hospital or nursing home)	Gives a family caregiver a break.	Up to 5 consecutive days at a time.
General inpatient care	Hospice inpatient unit, hospital or nursing home	Pain or symptoms that cannot be managed in any other setting.	Short-term, until symptoms are controlled.

Source: 42 CFR 418.302 (Medicare hospice payment rules); Medicare.gov.

What hospice costs the patient under Medicare

Out-of-pocket costs under the Medicare hospice benefit are very low compared with almost any other kind of care.

Item	What the patient pays (2026)
Hospice team visits, equipment, supplies	$0 from a Medicare-approved hospice
Outpatient drugs for pain and symptom control	Up to $5 per prescription
Inpatient respite care	5% of the Medicare-approved daily amount; total respite copays can’t exceed the Part A inpatient deductible ($1,736 in 2026)
General inpatient and continuous home care	$0
Room and board at home or in a facility	Not covered (except during short inpatient or respite stays arranged by hospice)
Care unrelated to the terminal illness	Normal Medicare deductibles and coinsurance

Source: Medicare.gov, Hospice care; CMS 2026 Medicare Parts A and B premiums and deductibles fact sheet.

One note on the $5 copay: many hospices waive it, so ask. And because the hospice is responsible for all drugs related to the terminal diagnosis, families should not be paying pharmacy bills for those medications through Part D.

What about Medicare Advantage?

If your loved one is in a Medicare Advantage plan, Original Medicare still pays for hospice once they elect it. They do not need to leave their plan, and the plan can continue to cover care unrelated to the terminal illness plus any extra benefits it offers. CMS tested letting some Advantage plans manage hospice directly, but that test ended on December 31, 2024.

Medicaid hospice

Hospice is an optional Medicaid benefit, which means each state decides whether to offer it, but the benefit is modeled on Medicare’s and most states cover it. Eligibility rules (terminal illness, six-month prognosis, choosing comfort care) generally mirror Medicare.

Medicaid matters most in two situations:

• People with Medicaid but not Medicare, such as adults under 65 with low income.
• Nursing home residents who have both Medicare and Medicaid (“dual eligibles”). Medicare pays for the hospice services, and Medicaid pays the nursing home room and board through the hospice. Federal law requires that payment to be at least 95% of what Medicaid would otherwise pay the facility.

Children under 21 on Medicaid or CHIP can receive hospice and curative treatment at the same time, a rule added by the Affordable Care Act. Medicaid home and community-based services waivers may also pay for personal care aides at home in some states, which can fill the caregiving gap that hospice leaves. Our guide to whether Medicaid pays for assisted living explains how those waivers work. Coverage details vary by state, so confirm with your state Medicaid agency.

Private insurance and long-term care insurance

Most employer and marketplace health plans cover hospice, often with rules similar to Medicare’s. Check the plan documents or call the insurer for:

• Whether the hospice must be in network
• Any deductible, copay or coinsurance
• Whether prior authorization is needed
• Any limit on the number of days or visits

Long-term care insurance is a separate product. Many policies pay for home care aides once the policyholder needs help with daily activities, and some include a hospice benefit. This can be the most useful source of money for the extra caregiving hours that hospice does not provide.

VA hospice for veterans

Hospice is part of the standard medical benefits package for veterans enrolled in VA health care. Veterans qualify if they have a terminal condition with a life expectancy of about six months or less and are no longer seeking treatment other than comfort care. According to the VA, there are no copays for hospice, whether the VA provides it directly or pays a community hospice agency under contract.

VA hospice can be delivered at home, in a VA Community Living Center or through a contracted community agency. Veterans who also have Medicare can choose which benefit to use. Talk with a VA social worker to set it up. Veterans and surviving spouses who need help paying for caregivers may also qualify for the VA pension with Aid and Attendance; see our guide to VA Aid and Attendance for assisted living and home care.

Comparison: who pays for hospice at home

Payer	Who qualifies	Patient cost	Pays for 24/7 caregivers?	Pays room and board?
Medicare	Part A, 6-month prognosis, comfort care	Up to $5 per drug; 5% of respite	No (only continuous care in a crisis)	No, except short inpatient or respite stays
Medicaid	Medicaid-eligible, similar medical criteria, varies by state	Little or none	No, but some state waivers fund personal care aides	Yes for nursing home residents on Medicaid
VA	Enrolled veterans, about 6-month prognosis	No copay	No	Covered in VA inpatient settings; not at home
Private insurance	Depends on plan	Plan deductibles or copays	Rarely	Rarely
Long-term care insurance	Depends on policy triggers	Elimination period, then policy pays up to a daily limit	Can pay for home aides	Some policies pay facility costs

Sources: Medicare.gov; VA Geriatrics and Extended Care; NHPCO Medicaid hospice issue brief.

What hospice does NOT cover

Knowing the gaps up front saves families a lot of stress later. Medicare hospice does not pay for:

• Treatment meant to cure the terminal illness, including drugs aimed at a cure rather than comfort. If the patient wants to try a curative treatment, they can revoke hospice and return to regular Medicare coverage.
• Room and board. Rent, mortgage and food at home, and the monthly fee in an assisted living community or nursing home, are not covered. The exception is a short inpatient or respite stay the hospice arranges.
• Round-the-clock caregivers. Routine hospice is a set of visits. Continuous home care is available only during short crises and must be mostly nursing care.
• Care from providers the hospice did not arrange. This includes hospital visits and ambulance rides related to the terminal illness, unless the hospice set them up. Call the hospice before calling 911 for anything related to the diagnosis.

Does hospice cover 24-hour care at home?

Usually no. Hospice provides 24-hour access (a nurse on call by phone, and visits for urgent problems), not 24-hour presence. Around-the-clock nursing at home is covered only as continuous home care during a medical crisis, such as pain that is not responding to medication or acute breathing distress. It requires at least 8 hours of mostly nursing care in a day and ends once the crisis is under control. If symptoms cannot be managed at home, the hospice can move the patient to general inpatient care instead.

Why families still need to arrange caregivers

As illness progresses, a person on hospice often needs help with everything: turning in bed, toileting, eating, taking medications and being watched overnight. Hospice aides may come several times a week for an hour or so, and nurses visit on a schedule. The rest of the time, someone else has to be there.

Families usually cover these hours in one of three ways:

1. Family and friends take shifts, with the hospice team teaching them what to do.
2. Paid home care aides are hired privately through an agency or independently, often for nights or weekends.
3. Program funding pays for some aide hours, such as a Medicaid waiver, VA Homemaker and Home Health Aide care, VA Aid and Attendance, or long-term care insurance.

What private caregivers cost

CareScout’s 2025 Cost of Care Survey put the national median for a non-medical home caregiver at $35 an hour, up 3% from 2024. Here is what that means for common hospice schedules:

Schedule	Hours per month (approx.)	Monthly cost at $35/hour
4 hours a day, 5 days a week	87	About $3,045
8 hours a day, 7 days a week	243	About $8,505
12-hour overnight shifts, 7 nights	365	About $12,775
24 hours a day, 7 days a week	730	About $25,550

Source: CareScout 2025 Cost of Care Survey (national median hourly rate); monthly figures are SeniorCare.Services calculations using 30.4 days per month.

Rates vary widely by state and city, and agencies often charge more for overnight, weekend or live-in arrangements (live-in care is often billed as a daily rate rather than hourly). For a deeper breakdown, see how much in-home care costs. If the patient needs skilled care but is not ready for hospice, the separate Medicare home health benefit may apply; see does Medicare cover home health care.

Hospice in assisted living or a nursing home

“At home” means wherever the person lives, so residents of assisted living communities and nursing homes can receive hospice without moving. The hospice team visits the facility, coordinates with staff and brings in equipment and medications.

The bill splits like this:

• Medicare pays the hospice for hospice services.
• The resident keeps paying the facility for room, board and the community’s own care services. In assisted living that typically means the regular monthly fee (see how much assisted living costs). In a nursing home, Medicaid pays room and board for residents who qualify; otherwise it is private pay (see how much a nursing home costs).

One trap: a resident in a nursing home on a Medicare-covered skilled stay generally cannot use Medicare’s skilled nursing facility benefit and hospice for the same condition at the same time. Electing hospice usually ends Medicare coverage of the nursing home stay for that condition, and room and board becomes private pay or Medicaid. Ask the facility’s business office before electing hospice. Assisted living communities may also have rules about how much care they can provide as needs increase, so talk to them early. Our guide on when to move from assisted living to a nursing home covers those limits.

How to choose a hospice: step by step

1. Ask the doctor for a hospice evaluation. Anyone can call a hospice to ask for an evaluation, but a referral from the patient’s doctor speeds things up.
2. Look up local agencies on Medicare Care Compare. Search “hospice” at Medicare.gov/care-compare to see Medicare-certified agencies, quality measures and results from surveys of family caregivers.
3. Call two or three agencies. Use the questions below and compare how quickly they can start.
4. Check insurance. If the patient has Medicare Advantage, Medicaid or private insurance, confirm which hospices they work with.
5. Sign the election statement. The patient (or their legal representative) signs it with the chosen hospice.
6. Plan the caregiving schedule. Map out who covers which hours, and line up paid help or respite before you need it.

Questions to ask a hospice agency

• How often will the nurse and aide visit, and can that increase as needs change?
• How fast does a nurse respond to an after-hours call, and will they come out at night?
• Do you provide continuous home care during a crisis? How often have you done so recently?
• Which inpatient facilities do you use for respite and general inpatient care?
• Do you waive the $5 drug copay?
• What volunteer and bereavement services do you offer?
• Do you have experience with dementia, heart failure, COPD or the patient’s specific illness?

Hospice vs palliative care

The two are often confused. Both focus on comfort and quality of life, but palliative care can start at any stage of a serious illness and alongside curative treatment.

	Hospice care	Palliative care
Who it is for	Terminal illness, prognosis of 6 months or less	Anyone with a serious illness, at any stage
Curative treatment	Stopped for the terminal illness	Can continue at the same time
Where it happens	Mostly at home or in the patient’s residence	Mostly hospitals and clinics; some home programs
How Medicare pays	Hospice benefit (Part A), daily rate to the agency	Like other medical visits, usually Part B with 20% coinsurance
Equipment, drugs and supplies	Included for the terminal illness	Billed separately under normal coverage
Family support	Includes caregiver training, respite and bereavement	Varies by program

Source: Medicare.gov; SeniorCare.Services summary.

For people living with dementia, the timing of hospice can be hard to judge because decline is slow. Our guides to memory care and Medicare coverage for dementia care explain the options before and alongside hospice.

FAQs

Who pays for hospice care at home?

Medicare pays for most home hospice through the Medicare hospice benefit. Medicaid, the VA and most private health plans also cover hospice. The patient’s family usually pays for any extra caregiver hours and for room and board.

Is hospice care at home free?

Nearly. Under Medicare, hospice services, equipment and supplies cost the patient nothing. The patient may owe up to $5 per prescription for symptom drugs and 5% of the cost of inpatient respite care. Private caregivers and housing costs are not covered.

Does hospice cover 24-hour care at home?

Only during a short medical crisis. Continuous home care provides at least 8 hours a day of mostly nursing care until symptoms are controlled. Otherwise hospice provides scheduled visits and a nurse on call 24/7, not a caregiver in the home all day.

How long can someone stay on hospice?

There is no fixed limit. Medicare covers two 90-day periods followed by an unlimited number of 60-day periods, as long as a doctor recertifies that the person is terminally ill. A face-to-face visit is required before the third period and each one after.

Can you leave hospice and come back?

Yes. A patient can revoke hospice at any time, for example to try a new treatment, and return to regular Medicare coverage. They can elect hospice again later if they still qualify.

Does Medicare pay for hospice in assisted living?

Medicare pays for the hospice services delivered in assisted living, but not the community’s monthly rent or care fees. Residents keep paying the community as before.

Does hospice pay for nursing home room and board?

Medicare does not. For residents who qualify for Medicaid, Medicaid pays room and board through the hospice. Otherwise, the resident pays privately or with long-term care insurance.

What is respite care in hospice?

Respite care is a short inpatient stay, up to five days at a time, in a hospice unit, hospital or nursing home so that family caregivers can rest. Under Medicare, the patient pays 5% of the approved daily amount.

Do I have to give up my Medicare Advantage plan to get hospice?

No. Original Medicare pays for hospice, and you can stay in your Advantage plan for care not related to the terminal illness and any extra benefits the plan offers.

Is hospice only for the last few days of life?

No. Hospice is designed for the last six months or so, and families often say they wish they had started sooner. Early enrollment gives the team time to control symptoms, train caregivers and plan ahead.

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Related guides

• Does Medicare cover home health care?
• How much does in-home care cost?
• Does Medicare pay for nursing home care?