Hospice is unusual in cash-pay healthcare because the price is public. CMS publishes a national daily rate for each of the four levels of hospice care every year, and almost every payer in the country, public or private, works off that schedule. There is no chargemaster to decode and no negotiated rate hidden behind a plan.
That does not answer the question families are usually asking, which is not “what does hospice cost” but “who is actually going to be on the hook here.” If the person is on Medicare, the answer is short and is covered in the Medicare hospice benefit guide: Medicare pays the hospice directly and bills the patient up to $5 per symptom prescription and 5% coinsurance for respite. This page is about everybody else. All figures were verified on September 6, 2026.
Who Actually Pays
| Payer | Covers hospice? | What the patient owes | Room and board |
|---|---|---|---|
| Medicare Part A | Yes, in full | Up to $5 per symptom prescription, 5% for respite | Not covered |
| Medicaid | Yes, in essentially every state | Varies by state, often nothing | Covered at 95% of the SNF rate for qualifying nursing facility residents |
| VA (enrolled veterans) | Yes | No copays | Covered in a VA Community Living Center inpatient hospice setting |
| TRICARE | Yes, in the U.S. and territories | Plan cost sharing, no charge for the hospice benefit itself | Only during inpatient or respite care |
| Employer or marketplace plan | Usually, but plan by plan | Deductible, copay or coinsurance per your plan | Almost never |
| Self-pay (uninsured) | You are the payer | The full per diem, priced off the CMS schedule | Yours |
Medicaid Hospice
Medicaid hospice is technically an optional state plan service, which sounds precarious and is not. In KFF’s most recent state-by-state survey of Medicaid benefits, 46 states reported covering hospice, zero reported not covering it, and five did not report a value. Treat it as universally available and verify with your own state’s Medicaid agency.
Structurally it mirrors Medicare. Medicaid.gov states that payment is made from a Medicaid hospice rate letter CMS issues annually, effective October 1 through September 30, using the same four levels of care, the same two-tier routine home care split at day 61, and the same service intensity add-on for nurse and social worker visits in the last seven days of life. States may pay more than that published minimum, and they may elect to apply the payment cap and the quality-reporting reduction.
Two things make Medicaid meaningfully better than Medicare for some families.
Room and board in a nursing facility. This is the single largest financial difference in the entire hospice system. For a Medicaid long-term-care resident who elects hospice, Medicaid reimburses the hospice for nursing facility room and board at a rate equal to 95% of the skilled nursing facility rate, less any post-eligibility treatment of income amount, and the hospice passes that payment through to the facility. Medicare pays none of that. If getting to Medicaid eligibility is plausible, it is worth the effort: see Medicaid spend-down, the 5-year look-back period and how to pay for a nursing home.
Concurrent care for children. Since the Affordable Care Act took effect in March 2010, Medicaid and CHIP-eligible individuals under age 21 who elect hospice no longer have to waive curative treatment. They can receive both at once, which is not true for adults on either program.
For everything else Medicaid does and does not pay for in this situation, see what Medicaid covers.
VA and Military Coverage
The VA covers hospice for enrolled veterans as part of the VHA Standard Medical Benefits Package, so eligibility is a clinical question rather than a benefits question. The VA’s own page states plainly that there are no copays for hospice care, whether the VA delivers it or a community hospice does under VA contract. Inpatient hospice is available at some VA Community Living Centers.
TRICARE covers hospice in the United States, the District of Columbia and U.S. territories, but not overseas. It uses the same benefit period structure as Medicare (90 days, 90 days, then unlimited 60-day periods) and requires an election statement filed with the regional contractor. TRICARE does not cover room and board except during inpatient or respite care, and cancelling hospice forfeits the remaining days in that benefit period. Beneficiaries under 21 can receive hospice and curative care together, and the benefit periods do not apply to them. For premiums and cost shares, see TRICARE cost, and family members of certain veterans should check CHAMPVA.
Private, Employer and Marketplace Plans
Here is the gap most people do not expect. Hospice is not one of the ten essential health benefits that every Marketplace plan must cover. HealthCare.gov’s list runs from ambulatory services and hospitalization through prescription drugs and pediatric care, and hospice is not on it. States can require more, and specific services inside each broad category vary by state.
In practice, the Hospice Foundation of America notes that many employer and state marketplace plans do offer a hospice benefit, but at levels that vary plan to plan and against Medicare. That means you should never assume. Before electing hospice on a commercial plan, get in writing: whether hospice is covered at all, what daily rate the plan pays, whether the hospice you want is in network, whether prior authorization is required, and what your deductible and coinsurance exposure is. A hospice admissions office will usually run the verification for you in a day.
One quirk worth knowing if the patient is 65 or older on a Medicare Advantage plan: hospice is carved out to Original Medicare regardless, so the Advantage plan is not the hospice payer even though it stays in force for everything else.
Self-Pay: What Hospice Costs If You Pay Cash
Hospices do accept private payment, referred to in the industry as self-pay, and the Hospice Foundation of America lists it as a real option for patients without insurance.
There is no national survey of what hospices charge private payers, so treat any single quoted number with suspicion. The defensible benchmark is the public CMS schedule, because that is what nearly every hospice’s cost accounting is built around. Under the FY2026 rates in effect through September 30, 2026, Medicare pays $230.83 a day for routine home care in the first 60 days, roughly $6,900 for a 30-day month, and $181.94 a day after that. Those rates rise about 2.3% on October 1, 2026. The full per-diem table for all four levels of care, including the inpatient rates, is in our hospice care cost guide.
That benchmark is genuinely useful leverage. Walk into an admissions conversation knowing the Medicare rate for the level of care you need, and ask the hospice to price self-pay against it. This is one of the few corners of American healthcare where the fair price is published by the government, and our fair price checker is built for exactly this kind of comparison.
Remember that self-pay covers the hospice services only. Room and board at home is nothing, but in assisted living or a nursing facility the housing bill is separate and unchanged, which is the same trap described in does Medicare cover long-term care.
Charity Care and the Nonprofit Question
If nobody can pay, ask anyway. The Hospice Foundation of America states that many hospice providers have a process for people who are medically eligible for hospice but have neither insurance nor the financial resources to pay for end-of-life care. That process usually has a name at each agency, often community benefit, indigent care or charity care, and it is administered by the admissions office or a social worker rather than advertised on the website.
Do not assume, though, that the industry is mostly charitable. It used to be, and it is not anymore. MedPAC’s March 2026 report counted 6,706 Medicare-certified hospices in 2024, of which 5,497 were for profit, 1,070 were nonprofit and 130 were government owned. That is about 82% for profit, up sharply over a decade, and nonprofit and government hospices together are now under a fifth of all providers. For-profit agencies furnished about 60% of Medicare hospice patients’ care.
The practical takeaway is to shop. In most metro areas several hospices serve the same territory, their charity care policies differ, and nonprofit and hospital-affiliated agencies are the more likely to have a funded program. Call more than one.
How to Pay Less
Ask about charity care first, not last. Our guide to hospital charity care explains how these programs are structured and what to ask for, and the same script works on a hospice admissions office. Start with our charity care checker.
Chase Medicaid eligibility if a facility is involved. The 95% room-and-board pass-through is the difference between a five-figure annual bill and close to none. Medicaid spend-down is the route.
Get the non-covered list in writing. Every hospice must give you an addendum listing what it has decided is unrelated to the terminal illness and will not cover. From October 1, 2026 CMS requires hospices to hand it to everyone electing hospice, not only those who ask. It is the earliest warning of a bill headed your way.
Separate the drug bill from the hospice bill. Drugs unrelated to the terminal illness fall outside the hospice benefit. Prescription assistance programs and the Medicare Prescription Payment Plan both apply.
Audit and negotiate anything you are billed. Unrelated care is billed normally, with the same error rates as any other medical bill. Read the itemized bill, then use our negotiation guide or set up a payment plan rather than letting a balance age into collections.
The Bottom Line
For most Americans, Medicare pays for hospice and the patient owes almost nothing. For everyone else there is a real ladder: Medicaid in essentially every state and the only payer that touches nursing facility room and board, the VA with no copays for enrolled veterans, TRICARE for military families, and commercial plans that usually cover hospice but on their own terms because it is not a required essential health benefit.
If you are uninsured, the situation is better than it looks. The benchmark price is published, self-pay is normal, and charity care exists at a lot of agencies. The one thing that reliably costs families money is not asking.