Does Medicare Pay for the Nursing Home If You're on Hospice?

In most cases, no. When your loved one lives in a nursing home and elects the Medicare hospice benefit, Medicare pays the hospice for the care related to the terminal illness — nursing visits, medications, medical equipment, social work, chaplain, aide help — but it does not pay the nursing home's daily room-and-board charge. That bill (the cost of “the bed,” meals, and basic housing) remains the family's responsibility unless another payer, usually Medicaid, covers it.

Why “room and board” is the catch

Room and board means the daily charge a facility makes for housing, meals, and routine personal care — separate from medical treatment. Under Routine Home Care, the level of hospice care most people receive (and “home” here includes a nursing home that is the patient's residence), Medicare's hospice payment does not include that daily facility charge. So the hospice team comes to the nursing home and Medicare pays them, but the nursing home still charges for the living space and meals.

There are two narrow exceptions where Medicare does cover the bed itself, because the stay is a hospice level of care rather than ordinary residence: general inpatient care (GIP) for short-term crisis symptom management that can't be controlled at home, and inpatient respite care to give a family caregiver a break (up to 5 consecutive days per stay, with a coinsurance of 5% of the Medicare-approved amount). These are temporary. They are not a way to have Medicare pay for a long-term nursing-home placement. Our setting-by-setting room-and-board guide walks through each scenario.

Where Medicaid changes the picture

If your loved one is “dual-eligible” — enrolled in both Medicare and Medicaid — Medicaid may cover the nursing-home room and board while Medicare covers the hospice care. In participating states, when a Medicaid resident of a nursing facility elects hospice, the state Medicaid program can pay the facility a room-and-board rate (commonly cited as around 95% of the facility's daily Medicaid rate, paid through the hospice, though the exact rate varies widely by state). Rules and eligibility vary by state, so the practical answer for a specific family depends on income, assets, and which state you're in.

If your loved one has only Medicare and no Medicaid, expect to pay the nursing home privately or from long-term-care insurance. Medicare does not turn into a room-and-board payer just because hospice was elected.

The misconception, corrected

The common belief is: “Mom's on hospice now, so Medicare will cover her nursing home.” That confuses two different things. Electing hospice gives her excellent, fully covered care for the terminal illness with little or no out-of-pocket cost (hospice drug copays are limited to up to $5 per prescription, for example). It does not convert her housing cost into a Medicare expense. The care is covered; the bed is not (outside GIP and respite). Families who don't separate these can be blindsided by a facility invoice that hospice was never going to pay.

What the two bills look like in practice

Once hospice is elected for a nursing-home resident, expect two separate financial relationships, and it helps to picture them side by side. The hospice bills Medicare for its services and you should see little or nothing for that part — no charge for routine visits, equipment, or symptom medications tied to the terminal illness, and at most a small drug copay (up to $5 per prescription) that many hospices absorb. The nursing home continues its own monthly room-and-board invoice for housing, meals, and routine personal care, exactly as it did before hospice. Those facility charges vary widely by region and facility and are not set by Medicare. If a single bill seems to mix the two, ask the facility business office and the hospice to itemize which payer covers which line. A good hospice will give you this breakdown in writing at intake so the facility invoice never arrives as a shock.

The skilled-nursing-facility benefit is a different thing

Families sometimes confuse two unrelated Medicare benefits. Medicare's skilled nursing facility (SNF) benefit can pay for a limited stay (after a qualifying hospital admission) when a patient needs short-term skilled rehab or nursing — but that is a recovery benefit, not a hospice benefit, and it is time-limited and conditional. The hospice benefit, by contrast, is comfort-focused care for a terminal illness and does not include long-term nursing-home room and board. A patient generally cannot use the SNF benefit and the hospice benefit to cover the same room at the same time for the same condition. So “Medicare paid for the nursing home during rehab” does not mean Medicare will pay for the nursing home once the goal shifts to hospice comfort care. Keep the two benefits mentally separate when you plan. If a patient is mid-rehab on the SNF benefit and then chooses hospice, the social worker can explain how the transition is handled and what the family will owe once the rehab coverage ends and Routine Home Care begins.

Who pays the bed, by situation

For a nursing-home resident on hospice at Routine Home Care, the likely payer for room and board depends on the patient's other coverage:

Situation	Who typically pays the room and board
Medicare only	The family, privately or via long-term-care insurance
Dual-eligible (Medicare + Medicaid), participating state	Medicaid, paid through the hospice — see does Medicaid pay nursing-home room and board on hospice
Short symptom crisis (GIP)	Medicare hospice covers the inpatient stay; no separate room charge
Caregiver break (inpatient respite)	Medicare hospice covers the bed, with a 5% coinsurance, up to 5 consecutive days per stay

The two inpatient rows are explained in GIP vs. inpatient respite: who pays for the bed.

Frequently asked questions

My mother's nursing home is covered now — will that continue on hospice?

It depends on why it is covered now. If a short-term SNF/rehab benefit is paying, that ends when the rehab goal does. If Medicaid is paying because she is dual-eligible, that coverage generally continues after she elects hospice in a participating state. Medicare's hospice benefit itself will not start paying the room.

Can we use GIP or respite to avoid the room-and-board bill long term?

No. GIP is for short-term symptom crises and respite is capped at up to 5 consecutive days per stay. Neither is a way to make Medicare pay for ongoing nursing-home residence.

If she has no Medicaid, is there any way Medicare pays the bed?

Not for long-term residence. Outside the short GIP and respite levels, Medicare hospice pays for care, not the nursing-home bed. Ask the social worker whether a Medicaid application makes sense, and check long-term-care insurance.

Does the answer change in assisted living instead of a nursing home?

The principle is the same: Medicare hospice pays for the team and supplies, not the room. Assisted-living room and board is private-pay in most cases, and Medicaid waiver programs vary by state.

Practical next steps

• Ask the nursing home for the room-and-board rate in writing and confirm what continues once hospice is elected.
• Check dual-eligibility. If your loved one might qualify for Medicaid, ask the facility's business office or a benefits counselor; in many states Medicaid then covers the room-and-board portion.
• Get the division of charges from the hospice. A good hospice will explain exactly what Medicare's hospice benefit pays and what the facility still bills.
• Compare providers before you choose. Compare Medicare-certified hospices near you and review each one's CMS Care Compare and family-survey scores.
• Understand timelines too: see how long you can stay on hospice, since nursing-home residents often remain enrolled for many months.

Bottom line: hospice care in a nursing home is covered by Medicare; the nursing-home room and board generally is not. For dual-eligibles, Medicaid may step in to cover the bed in participating states. Confirm the split early so the facility bill never comes as a surprise.