What Hospice Pays For and What It Doesn't
Hospice does not pay for a nursing home bed itself. Hospice is a service — it covers medical care, pain management, counseling, and comfort supplies for someone with a terminal illness. The nursing home is the place where that person lives, and someone else pays the rent. That someone is usually Medicare, Medicaid, the resident, or their family.
If a nursing home resident is on hospice, the hospice agency pays for the hospice services delivered in that room. The nursing home continues to bill for room, board, and basic nursing care. These are two separate bills from two separate organizations.
The confusion happens because hospice and nursing home care can overlap. A person can be in a nursing home and receiving hospice at the same time. But the payment sources stay separate unless the nursing home itself is a hospice facility — which is rare and different from a standard nursing home with hospice services added.
Key Takeaways
- Hospice pays for medical services and comfort care, not for the nursing home room or board.
- Medicare and Medicaid are the most common payers for nursing home costs when someone is on hospice.
- A nursing home resident on hospice receives two bills: one from the nursing home and one from the hospice agency.
- If a nursing home resident cannot afford both costs, a social worker can help find programs that cover the gap.
How Medicare Covers Hospice and Nursing Home Separately
If the person has Medicare, here is how the payments work. Medicare Part A covers up to 100 days in a skilled nursing facility after a hospital stay. During those 100 days, if the person is also on hospice, Medicare pays the hospice agency for hospice services. The nursing home is still paid by Medicare Part A for the room and care.
After the 100 days end, Medicare no longer pays the nursing home bill. At that point, the person must pay out of pocket, use Medicaid, or rely on another source. Hospice can continue as long as the person is still may be able to access — meaning they still have a terminal diagnosis and have chosen comfort care over curative treatment.
The hospice benefit itself has no time limit under Medicare. A person can be on hospice for months or years if they meet the criteria. But the nursing home coverage ends, and that is where the cost gap opens.
How Medicaid Covers Nursing Home When Hospice Is Involved
Medicaid is the program most likely to pay for long-term nursing home care. If someone is on Medicaid and also on hospice, Medicaid continues to pay the nursing home. The hospice agency bills Medicaid or Medicare (whichever the person has) for hospice services.
Medicaid rules vary by state. Some states cover hospice through Medicaid; others require the person to have Medicare as the primary payer. A social worker at the nursing home or hospice agency can tell you what your state covers and whether the person's Medicaid will pay both bills.
One important note: Medicaid has strict rules about assets and income. If a nursing home resident is on Medicaid and receives a large sum of money or inheritance, it can affect their Medicaid status. This matters when planning for hospice and long-term care together.
When the Person Pays Out of Pocket
If someone does not have Medicare or Medicaid, or if their Medicare days run out, they or their family pay the nursing home directly. This can cost $100 to $300 per day or more, depending on the facility and the state. Hospice services are then billed separately, usually to Medicare if the person has it, or out of pocket if they do not.
Many families face this situation. The nursing home bill continues whether the person is on hospice or not. Hospice does not reduce the nursing home cost. What it does is change the focus of care from treatment to comfort, which often means fewer hospital visits and fewer expensive interventions.
If the cost becomes unmanageable, the nursing home social worker can discuss Medicaid process, payment plans, or other resources. Some nursing homes have charity care funds or partnerships with local nonprofits that help cover gaps.
What Hospice Services Actually Cover
Hospice covers the medical and comfort side of end-of-life care. This includes doctor visits, nursing care focused on comfort rather than cure, pain medication, counseling for the patient and family, spiritual care if wanted, and supplies like wound dressings or oxygen. Hospice also covers short-term inpatient care if pain or symptoms cannot be managed at home or in the nursing home.
Hospice does not cover the cost of living in the nursing home — the room, meals, laundry, activities, or basic custodial care. Those are the nursing home's responsibility to bill for. Hospice also does not cover medications unrelated to the terminal illness or comfort, though this varies by plan.
The hospice team works alongside the nursing home staff. They do not replace the nursing home nurses; they add specialized end-of-life care. This coordination is important because it means the person gets both the comfort focus of hospice and the daily care structure of the nursing home.
Questions to Ask Before Choosing Hospice in a Nursing Home
Before enrolling in hospice while in a nursing home, ask the social worker or hospice intake coordinator these questions: Does Medicare or Medicaid cover both the nursing home and hospice? If not, who pays the gap? How long will the nursing home be paid for? What happens when that time ends? Does the hospice agency have experience working in this particular nursing home?
Also ask whether the person can stay in the same nursing home room or if they will be moved. Some facilities have a dedicated hospice wing; others provide hospice services in the regular rooms. Ask what happens if the person's condition improves — can they come off hospice and resume regular nursing home care, or will they have to leave?
These questions matter because they affect both the quality of care and the financial picture. A nursing home social worker should be able to answer most of them or connect you with someone who can.
What Happens When Nursing Home Coverage Ends
If Medicare covers 100 days and those days run out, the nursing home will send a discharge notice. At that point, the person must either pay privately, switch to Medicaid, or move to a different facility. Hospice can continue regardless — the person can receive hospice at home, in an assisted living facility, or in a different nursing home.
This is where planning ahead matters. If someone is in a nursing home on Medicare and also on hospice, the family should start thinking about what comes next before day 100 arrives. A social worker can help explore Medicaid, discuss whether staying in the same facility is possible, or plan a move to a Medicaid-certified home.
Some people choose to go home on hospice rather than stay in a nursing home after Medicare coverage ends. Others move to a facility that accepts Medicaid. The hospice agency can support the person in any of these settings.
Frequently Asked Questions
If someone is on hospice in a nursing home, do they still need to pay the nursing home bill?
Yes. Hospice and nursing home are separate services with separate bills. Hospice pays for medical comfort care; the nursing home bill covers the room and basic care. Whoever was paying the nursing home before (Medicare, Medicaid, or private pay) continues to pay it while the person is on hospice.
Can hospice help pay for a nursing home if the family cannot afford it?
Hospice itself does not pay nursing home costs. However, the hospice social worker or the nursing home social worker can help the family explore Medicaid, payment plans, or local information programs. They can also discuss whether home hospice or a different care setting might be more affordable.
What if someone runs out of Medicare days while on hospice?
The nursing home coverage ends, but hospice can continue. The person or family must then pay the nursing home privately, switch to Medicaid, or move to a different facility. The hospice agency will help coordinate care in whatever setting the person moves to.
Does being on hospice change how much the nursing home charges?
No. The nursing home bill stays the same whether the person is on hospice or not. Hospice is an additional service that is billed separately. The nursing home does not reduce its charges because hospice is involved.
Who should I call if I do not understand the bills?
Start with the nursing home social worker or billing department. They can explain what the nursing home is charging for and who is paying it. Then contact the hospice agency's billing department to understand the hospice charges. Both should be able to walk you through the payment sources.