Almost everything in long-term care is a cash-pay problem. Hospice is the exception. It is the one service in this category that Medicare covers in full, with no deductible, and the numbers are published down to the cent by CMS every year.
That does not mean a hospice election is free. There are two real out-of-pocket items, one of them small and one of them large enough to reshape a family budget. This guide gives the FY2026 CMS per-diem rates for all four levels of hospice care, what the patient is actually billed, the room-and-board gap that catches most families off guard, and what happens if you have no coverage at all.
What Does Hospice Care Cost?
Medicare pays hospices a flat per-diem, not a fee per visit. There are four payment categories, distinguished by where care happens and how intense it is, plus a two-tier split within routine home care after day 60.
These are the FY2026 rates, in effect from October 1, 2025 through September 30, 2026, from the CMS final rule published in the Federal Register. The Low column is the reduced rate paid to hospices that fail to submit the required quality data (a four percentage point penalty). All rates are national base rates that get adjusted by the hospice wage index for your metro area.
| Service/Type | Low | Average | High |
|---|---|---|---|
| Routine home care, days 1-60 (per day) | $221.83 | $230.83 | $230.83 |
| Routine home care, days 61+ (per day) | $174.84 | $181.94 | $181.94 |
| Continuous home care (per hour, 8 to 24 hours) | $67.04 | $69.76 | $69.76 |
| Continuous home care, full 24 hours | $1,609.02 | $1,674.29 | $1,674.29 |
| Inpatient respite care (per day) | $511.72 | $532.48 | $532.48 |
| General inpatient care (per day) | $1,153.08 | $1,199.86 | $1,199.86 |
| What the patient pays for covered hospice services | $0 | $0 | $0 |
| Prescription copay for symptom drugs (each) | $0 | n/a | $5 |
| Inpatient respite coinsurance, 5% (per day) | n/a | about $27 | capped at the inpatient deductible |
| Room and board if you live in a facility (per month) | $6,200 | $9,581 | $10,798 |
CMS raised hospice rates 2.6% for FY2026, an estimated $750 million increase, and set the annual per-patient aggregate cap at $35,361.44. From October 1, 2026, the FY2027 final rule raises rates another 2.3% and lifts the cap to $36,174.75, so if you are pricing care for the fall, expect the numbers above to move up about 2%.
What the Four Levels of Care Mean
Routine home care is the default and covers the overwhelming majority of hospice days. It is paid for every day the patient is enrolled unless a higher level applies, and the rate steps down from $230.83 to $181.94 on day 61. That drop reflects CMS’s finding that hospice workload is heaviest at the start and at the very end of a stay, which is also why a service intensity add-on pays extra for nurse and social worker hours in the last seven days of life.
Continuous home care is crisis care at home, paid hourly, with a minimum of eight hours in a day. It is meant to prevent a hospital admission during an acute symptom episode.
Inpatient respite care is short-term facility care so the usual caregiver can rest. Medicare and Medicaid pay for a maximum of five days per respite admission, and day six onward reverts to the routine home care rate.
General inpatient care is for symptoms that cannot be managed anywhere else. At $1,199.86 a day it is the most expensive level, and it is meant to be short.
The Room-and-Board Gap
Here is the line that surprises families. Medicare pays for the hospice service. It does not pay room and board.
Medicare.gov states it plainly: room and board is not covered if you get hospice care in your home, or if you live in a nursing home or a hospice inpatient facility. The exception is short-term inpatient or respite care that the hospice team itself arranges.
So if a parent is already living in a nursing home or an assisted living community and elects hospice, the facility invoice keeps coming in full. Per the 2025 CareScout Cost of Care Survey, that is a national median of $9,581 a month for a shared nursing home room, $10,798 for a private room, and $6,200 a month for assisted living. Our guides to nursing home costs and assisted living costs break those down by state.
One partial fix exists on the Medicaid side. Where a resident qualifies for Medicaid long-term care, Medicaid reimburses the hospice for nursing facility room and board at 95% of the state’s skilled nursing facility rate, and the hospice passes that payment through to the facility. That is a Medicaid benefit, not a Medicare one, so it depends on the resident already being Medicaid-eligible for the nursing home stay.
If care is at home, there is no room-and-board bill at all, which is a large part of why routine home care is where most hospice days happen. What families often add on top is paid caregiving between hospice visits, priced separately in our home health care guide.
What You Actually Pay
For a Medicare-approved hospice, the covered services cost you nothing. There is no hospice deductible.
Two exceptions apply, and both are small:
- Up to $5 per prescription for outpatient drugs for pain and symptom management. If the hospice benefit does not cover a particular drug, the provider is supposed to check whether Part D does.
- 5% coinsurance for inpatient respite care. At the FY2026 respite rate of $532.48 a day that is roughly $27 a day, and by rule it can never exceed the inpatient deductible amount.
Separately, Original Medicare keeps paying for health problems unrelated to your terminal illness, with the normal deductible and coinsurance owed on those. Because “related” versus “unrelated” is where surprise bills come from, you can request an addendum to your Hospice Election Statement listing every item, service and drug the hospice has determined is unrelated and will not cover, along with why. Your provider must supply it within three to five days of the request. The FY2027 CMS final rule goes further and makes that addendum mandatory for every hospice election, not just on request.
Who Qualifies, and Why That Is a Cost Question
Eligibility is the gate on all of the above, so treat it as budgeting information rather than medical advice. Under Medicare rules you must:
- have Part A,
- have your hospice doctor and your regular doctor (if you have one) certify that you are terminally ill with a life expectancy of six months or less,
- accept comfort care instead of treatment intended to cure the terminal illness and related conditions, and
- sign a Hospice Election Statement before any hospice services begin.
Coverage runs as two 90-day benefit periods followed by an unlimited number of 60-day periods. Outliving the six-month prognosis does not end the benefit, it just requires recertification after a face-to-face visit. You can also stop hospice and return to curative treatment, then re-elect later.
Hospice use is now the norm rather than the exception. Per the National Alliance for Care at Home’s Facts and Figures 2025 edition, 1.91 million Medicare beneficiaries were enrolled in hospice during 2024, up 4.4% from 2023, and for the first time a majority (53.1%) of all Medicare decedents received hospice care and were enrolled at the time of death.
Cash Price vs. Insurance
Medicare is the dominant payer and covers essentially everything, as described above.
Medicaid hospice mirrors it. States pay hospices from the CMS Medicaid hospice rate letter published each year for the October to September period, using the same four levels of care and the same two-tier routine home care split. States may pay more than the published minimum, and states can elect the payment cap and the quality-reporting reduction.
VA benefits cover hospice for enrolled veterans as part of the VHA Standard Medical Benefits Package, with no copays, whether the care is delivered by the VA itself or by a community hospice under VA contract.
Employer and marketplace insurance commonly include a hospice benefit, but coverage levels vary plan to plan, so confirm the per-diem and any facility limits in writing before electing.
Self-pay exists and is straightforward: hospices accept private payment, and most price it against the same CMS per-diem schedule, which means routine home care lands near $230 a day (roughly $6,900 for a 30-day month) rather than at hospital-style chargemaster rates. That is a rare piece of good news in cash-pay healthcare, because the benchmark is public.
Charity care is the backstop. The Hospice Foundation of America notes that many hospice providers have a process for people who are medically eligible for hospice but have neither insurance nor the resources to pay. A large share of hospices are nonprofit and maintain community benefit funds for exactly this. Nobody should be turned away without being asked about it.
How to Pay Less
Ask about charity care before anything else if you are uninsured. Community and nonprofit hospices routinely absorb care for patients with no coverage. Our guide to hospital charity care explains how these programs are structured and what to ask for, and the same approach works on a hospice admissions office. Our charity care checker is a starting point.
Request the election statement addendum on day one. It is the list of everything the hospice will not cover as unrelated to the terminal illness, and it is the only reliable way to see a surprise bill before it arrives.
Price the room and board separately from the care. These are two different bills from two different organizations. Run the facility rate against the state medians in our nursing home and memory care guides, and through our fair price checker, before assuming a hospice election changes it.
Check whether Medicaid long-term care eligibility is within reach. It is what unlocks the 95% room-and-board pass-through in a nursing facility, and it is the difference between a $9,581 monthly bill and close to none.
Audit anything you are billed. Hospice patients still get bills for unrelated care, and those bills contain the same errors as any other. Our guide to reading an itemized bill and our negotiation guide both apply, and a hospice social worker will often help you push back.
Do not let a facility balance go to collections during a crisis. Our guide to medical bills in collections covers what protections apply and what timeline you are working against.
The Bottom Line
Hospice is the cheapest thing in long-term care for the patient and the family, because Medicare pays the hospice directly at $230.83 a day for routine home care in FY2026 and bills you nothing for it. Plan on up to $5 per symptom prescription and about $27 a day if you use respite care, and nothing else for the hospice services themselves.
The number to actually budget is the room and board, which Medicare never covers outside short-term inpatient and respite stays. At home that is zero. In assisted living or a nursing home it is $6,200 to $10,798 a month, unchanged by the hospice election. Settle that question first, ask about charity care if you are uninsured, and get the election statement addendum in writing so you know exactly which bills are still yours.