Does Medicare or Medicaid Cover Hospice? A Complete Guide for 2025

The short answer: Yes — Medicare covers hospice almost completely for eligible beneficiaries, and Medicaid covers hospice in all states. The Medicare Hospice Benefit pays for nursing, aides, medications related to the terminal diagnosis, counseling, and equipment. Understanding what's covered — and what's not — helps families avoid unexpected costs and access full benefits.

The Medicare Hospice Benefit

Medicare Part A (hospital insurance) covers the Medicare Hospice Benefit for eligible patients. To qualify:

• The patient must be Medicare-enrolled (Part A)
• A hospice physician and the patient's own physician must certify that life expectancy is 6 months or less if the disease follows its normal course
• The patient must choose hospice care and sign a statement electing the hospice benefit (waiving curative treatment for the terminal condition)
• Care must be provided by a Medicare-certified hospice program

What Medicare Hospice Covers

Medicare hospice benefit covers a comprehensive range of services with minimal cost-sharing:

• Physician services: Hospice physician and attending physician visits related to the terminal diagnosis
• Nursing care: Skilled nursing visits (not 24/7 unless in crisis care)
• Aide services: Home health aides for personal care
• Social work: Medical social worker services
• Spiritual care: Chaplain services
• Counseling: Bereavement counseling for family (up to 13 months after death)
• Medications: Drugs related to the terminal diagnosis (comfort-focused; some may have small copays up to $5)
• Equipment: Durable medical equipment — hospital bed, wheelchair, oxygen, bedside commode
• Supplies: Medical supplies related to comfort care
• Short-term inpatient care: For pain/symptom management crises (up to 5 days)
• Respite care: Up to 5 consecutive days in an inpatient facility to give home caregivers a break

What Medicare Hospice Does NOT Cover

• Room and board if the patient lives in a nursing home (nursing home costs are separate)
• Treatments intended to cure the terminal illness
• Prescription drugs unrelated to the terminal diagnosis (covered under Part D)
• Emergency room visits unrelated to the terminal diagnosis
• Death doula services (non-medical; not covered by Medicare)

Medicaid Hospice Coverage

Medicaid covers hospice in all 50 states plus DC. Federal law requires states to provide the Medicaid hospice benefit. Coverage is similar to Medicare hospice, with some state-specific variations. For dual-eligible patients (Medicare and Medicaid), Medicare typically pays first for hospice services, with Medicaid potentially covering room and board in some states.

Hospice Care Levels

Medicare pays different rates for four levels of hospice care:

1. Routine home care: Standard daily rate for care at home — the most common level
2. Continuous home care: Higher rate during crisis periods requiring 8-24 hours of nursing daily
3. Inpatient respite care: Short-term inpatient stay (up to 5 days) for caregiver respite
4. General inpatient care: Inpatient stay for pain/symptom management that can't be managed at home

Hospice Benefit Periods

There are no time limits on hospice. Benefit periods are structured as: two initial 90-day periods, followed by unlimited 60-day periods. A hospice physician must recertify eligibility (continuing 6-month prognosis) at each period renewal. If a patient outlives their prognosis, they can remain on hospice as long as they continue to meet eligibility criteria.

Frequently Asked Questions

Is hospice really free with Medicare?

Hospice is nearly free for Medicare beneficiaries. There is no deductible or coinsurance for hospice services. The only potential cost-sharing is a small copay (up to $5) for outpatient medications related to pain/symptom management, and a 5% copay for inpatient respite care. Most patients pay nothing or very little.

Can you go back on curative treatment after choosing hospice?

Yes. Patients can revoke the hospice election at any time and return to curative or disease-directed treatment. If prognosis improves or the patient wants to pursue active treatment again, they can leave hospice, receive curative care, and re-enroll in hospice later if needed. Hospice enrollment is not irreversible.

Does Medicare cover a hospital stay while on hospice?

Medicare covers short-term inpatient care while on hospice for acute pain or symptom management crises (general inpatient care) or short-term respite for caregivers (up to 5 days). ER visits for conditions unrelated to the terminal diagnosis are covered under regular Medicare. Hospitalizations for the terminal diagnosis are typically covered through hospice's inpatient benefit.

What happens to Medicare after the patient dies while on hospice?

Medicare hospice includes 13 months of bereavement support for family members after the patient's death — counseling, support groups, and check-in calls. This bereavement benefit is available to family regardless of whether the bereaved person is themselves a Medicare beneficiary.

Can a nursing home resident use the Medicare hospice benefit?

Yes, nursing home residents can elect the Medicare hospice benefit. Medicare pays for the hospice services (nursing, aides, medications, chaplain, social work, etc.), but Medicare hospice does NOT cover room and board at the nursing home. Room and board is paid by Medicaid (if eligible), long-term care insurance, or private pay.

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