Are You Responsible for a Parent's Medical Bills After They Die on Hospice?

Usually, no. Under federal consumer guidance from the Federal Trade Commission (FTC), family members usually do not have to pay a deceased relative's debts from their own money. A parent's unpaid medical bills are paid from their estate, the money and property they left, and if the estate is not enough, the debt usually goes unpaid. There are exceptions, such as a debt you cosigned, and the rules for a surviving spouse can be different. On top of that, most hospice care leaves little to bill in the first place.

What the hospice itself might bill

Medicare.gov says you pay nothing for hospice care from a Medicare-approved hospice. The small costs that can apply are:

• A copayment of up to $5 per prescription for outpatient drugs for pain and symptom management.
• 5% of the Medicare-approved amount for inpatient respite care, capped at the inpatient deductible.

The large dollar figures on Medicare statements are what Medicare paid the hospice, not what your family owes; see hospice billing: what the bills actually mean and hospice copays and coinsurance under Medicare. The bigger bill, when there is one, is usually a nursing home's or assisted living community's charge for room and board, which the Medicare hospice benefit does not cover.

Who pays: the estate, not the children

The FTC explains that a person's debts do not go away when they die. They are paid from the estate. The executor named in a will is responsible for paying them; if there is no will, a court may appoint an administrator or personal representative, and some states have other processes for naming someone. If there is not enough money in the estate, the debt usually goes unpaid.

The exceptions

The FTC lists situations where a person may be personally responsible:

• You cosigned the debt.
• You were the spouse and live in a community property state.
• You were the spouse and live in a state that requires a surviving spouse to pay certain debts, such as some health care expenses.
• You were responsible for settling the estate and did not follow your state's probate laws.

One more exception the FTC list does not cover: some states have "filial responsibility" laws that can make an adult child who has the means to pay responsible for an indigent parent's care. They are rarely used, but in 2012 a Pennsylvania appeals court upheld a nursing home's judgment of about $93,000 against a son for his mother's unpaid care under that state's law. If a facility or agency cites such a law, get legal advice in your state.

If any of these might apply, or the estate is complicated, talk with a probate or estate attorney in your state before paying anything.

Signing nursing home papers as a "representative"

Many adult children signed admission papers when a parent moved into a nursing home and later worry that this made them the guarantor. Federal rules for nursing facilities that take Medicare or Medicaid say the facility must not request or require a third-party guarantee of payment as a condition of admission or continued stay. The facility may ask a resident representative who has legal access to the resident's income or resources to sign a contract to pay the facility from the resident's money, without incurring personal financial liability (42 CFR 483.15). If a facility tells you that you personally owe the bill because you signed, ask it to show you exactly what you signed, and get legal advice before paying. This federal protection applies only to nursing homes certified by Medicare or Medicaid. An assisted living community's contract is governed by state law and its own terms, so a guarantee you signed there may be enforceable.

Medicaid estate recovery

If your parent's nursing home care was paid by Medicaid, the state may seek repayment from the estate. Medicaid.gov says that for people age 55 or older, states are required to seek recovery from the estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States may not recover from the estate while the person is survived by a spouse, a child under 21, or a blind or disabled child of any age, and states must have procedures to waive recovery when it would cause undue hardship. Recovery comes from the estate, not from children's own income. Your state Medicaid agency can explain how its program works. For background on how Medicaid pays for the room on hospice, see does Medicaid pay nursing home room and board on hospice. For whether the state can take the house, and when, see can Medicaid take the house after paying for hospice in a nursing home.

When a debt collector calls

The FTC explains what debt collectors can and cannot do under the Fair Debt Collection Practices Act. These rules cover collection agencies and others who collect debts owed to someone else. A hospital, nursing home or hospice billing office collecting its own bill in its own name is generally not covered, though your state's laws may apply:

• A collector may discuss the debt only with the spouse, the parent of a deceased minor, a guardian, the executor or administrator, a lawyer, or certain other authorized people. They may not discuss the debt with anyone else.
• They may contact other relatives to get the name and contact information of the person handling the estate, but they cannot discuss the debt with them.
• They cannot contact you before 8 a.m. or after 9 p.m. unless you agree.
• If you are the responsible person, you can stop contact by writing to the collector. Stopping contact does not erase the debt; the collector can still pursue the estate.

You can report problems to the FTC at ReportFraud.ftc.gov or to your state attorney general.

Practical steps after the death

• Do not pay medical bills out of your own pocket just because they arrive addressed to the family. Forward them to whoever is handling the estate.
• Check each bill against insurance. Confirm Medicare, Medicaid, or the private plan processed it. Apart from the small drug copays and respite coinsurance, care related to the terminal illness is covered by the hospice benefit and should not be billed to your parent's estate or to you.
• Keep copies of every statement and letter, and certified copies of the death certificate.
• Ask the hospice social worker for help sorting out bills from the final months.

Frequently asked questions

Can the hospice bill us after our parent dies?

Only for the small costs that may have applied while your parent was on hospice, such as drug copays or respite coinsurance, plus anything outside the hospice benefit. Those charges are owed by your parent's estate, not by you personally, unless an exception above applies.

I signed my mother's nursing home admission papers. Do I owe her bill?

Federal rules for Medicare- and Medicaid-certified nursing homes bar the facility from requiring a third-party guarantee of payment. A representative who signs to pay from the resident's own income or resources does not take on personal financial liability under that rule. Ask to see the contract and get legal advice if the facility insists otherwise.

What if my parent's estate has no money?

The FTC says that if the estate cannot cover a debt, it usually goes unpaid. Family members usually do not have to make up the difference from their own money.

Can Medicaid take my parent's house?

Medicaid estate recovery can reach the house after the death, but not while a spouse, a child under 21, or a blind or disabled child survives, and states must offer hardship waivers. For the full rules, including liens during life and what counts as the estate in your state, see can Medicaid take the house after paying for hospice in a nursing home.

What to do next

Gather the bills, identify who is acting for the estate, and confirm each charge went through insurance before anything is paid. If you are unsure whether a room-and-board charge is legitimate, start with hospice room and board: who pays.