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

Usually no. Medicare does not pay a nursing home's daily room-and-board charge for someone who lives there and is on hospice. Medicare pays the hospice for the care related to the terminal illness: nursing visits, medications, medical equipment, social work, chaplain and aide help. The room-and-board bill (the cost of “the bed,” meals, and basic housing) remains the resident's unless another payer, usually Medicaid, covers it. Medicare pays for a nursing-home bed only in the limited situations below, and none of them is a way to cover long-term living there.

When Medicare does pay for the bed

Situation	What Medicare pays, and the limits
Living in the nursing home on hospice (Routine Home Care)	The hospice care only. No room and board, for any length of stay.
General inpatient care (GIP)	The inpatient stay, with no room charge or coinsurance. It is short-term, for pain or symptoms that can't be managed in other settings, and must be in a hospital, a hospice inpatient unit, or a Medicare-certified skilled nursing facility that meets the hospice 24-hour nursing standards.
Inpatient respite	The stay, with a coinsurance of 5% of Medicare's respite payment, for up to 5 days in a row. It is for a patient cared for at home whose caregiver needs a break. Medicare's manual says it cannot be provided to someone who already lives in a facility such as a long-term care nursing home.
The skilled nursing facility (SNF) benefit, for a condition unrelated to the terminal illness	A semi-private room, meals and skilled care, if the usual rules are met, including an inpatient hospital stay of at least 3 days in a row and a daily skilled need. Up to 100 days per benefit period. In 2026 you pay $0 a day for days 1–20 after the $1,736 Part A deductible, and $217 a day for days 21–100. See Medicare skilled nursing care for an unrelated injury.

The two inpatient levels are explained in GIP vs. inpatient respite: who pays for the bed, and our setting-by-setting room-and-board guide walks through each scenario.

Why “room and board” is the catch

Medicare doesn't pay for long-term care in a nursing home for anyone, on hospice or not. 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. Under the written agreement the two must sign, the home keeps furnishing 24-hour room and board care, and the hospice provides its services plus the drugs, supplies and equipment for the terminal illness.

Where Medicaid changes the picture

If your loved one qualifies for Medicaid nursing-home coverage, Medicaid can pay the room and board while Medicare covers the hospice care. Federal law requires a state that covers hospice to pay at least 95% of what it would have paid the nursing home, and that money normally goes to the hospice, which pays the home. Someone with both programs must elect hospice under both at once. The resident generally keeps contributing their income above a personal needs allowance. Whether someone qualifies depends on income, assets, and the state; see does hospice room and board coverage differ by state.

If your loved one has only Medicare and no Medicaid, expect to pay the nursing home privately or from long-term-care insurance, unless the VA pays for an eligible veteran. Medicare does not turn into a room-and-board payer just because hospice was elected. The bill is the resident's, not automatically the family's: federal rules bar a home from requiring a third-party guarantee of payment. See hospice room and board: who pays.

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 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 the limited stays above). 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). For a resident paying privately, the nursing home continues its own monthly room-and-board invoice for housing, meals, and routine personal care. With Medicaid, the resident generally owes only the monthly share, which the home or the hospice collects depending on the state. If Medicare's SNF benefit was paying before hospice, that invoice may be new. 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, and ask the hospice for this breakdown in writing at intake.

The skilled-nursing-facility benefit is a different thing

Families sometimes confuse these two 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. The hospice benefit is comfort-focused care for a terminal illness and does not include long-term nursing-home room and board. So “Medicare paid for the nursing home during rehab” does not mean Medicare will pay once the goal shifts to comfort care.

Can you have both at once? Only for different conditions. Medicare's manual says a person can be in a SNF under the SNF benefit for a condition unrelated to the terminal condition while receiving hospice for the terminal condition. Electing hospice waives Medicare payment for other services related to the terminal illness, so SNF coverage for that illness stops. If the resident still needs long-term care when Medicare coverage ends, CMS says the home should offer ways to stay, which may include paying privately or getting help applying for Medicaid. If Medicaid is then denied, the resident owes for the days after Medicare stopped paying. Before electing hospice in the middle of a rehab stay, ask the business office what the resident will owe from that date.

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 resident, privately or via long-term-care insurance
Qualifies for Medicaid nursing-home coverage	Medicaid, normally paid through the hospice, after the resident's monthly share — see does Medicaid pay nursing-home room and board on hospice
Medicaid application pending	The resident, unless Medicaid approves coverage for those days. Federal rules generally let Medicaid reach back for some earlier months if the person would have qualified, though some states limit this (Florida ended its three-month reach-back for most adults 21 and older in 2019)
Veteran	VA, if the veteran meets its criteria — see does the VA pay for hospice room and board

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 Medicare's SNF benefit is paying for rehab related to the terminal illness, that stops when she elects hospice. If it is paying for an unrelated condition, it can continue while she meets its rules. If Medicaid is paying, electing hospice does not end that, though the payment normally moves through the hospice. Medicare's hospice benefit itself will not start paying the room.

How long will Medicare pay for the nursing home on hospice?

For ordinary residence, not at all. The hospice care itself has no fixed end date as long as she is recertified; see how long you can stay on hospice. The room charge continues for as long as she lives there.

Can she go off hospice so Medicare pays for rehab?

She can revoke hospice at any time, and the Medicare coverage she waived resumes. The SNF benefit would still need its usual rules, and it would not pay for long-term living there. CMS's manual notes that a hospital general inpatient stay of 3 days or more under hospice still counts as the qualifying stay if she then revokes. See can you leave hospice and resume treatment.

Does the nursing-home bill go down when hospice starts?

Don't count on it. Medicare does not set the home's rate, and the home keeps providing room and board. The hospice takes over the drugs, supplies and equipment for the terminal illness, so ask the business office whether any separate charges for those items stop.

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

No. GIP is for short-term pain or symptom crises, and respite is not available to someone who already lives in a nursing home. Neither is a way to make Medicare pay for ongoing nursing-home residence.

We can't care for her at home anymore. Will Medicare pay for a nursing home?

Not for living there. Hospice can continue in a nursing home, but the room and board is private pay unless Medicaid or another payer covers it. While she still lives at home, Medicare can cover a respite stay of up to 5 days in a row for a caregiver break, or a GIP stay if her symptoms need it. A breakdown in caregiving does not qualify for GIP by itself.

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

Not for long-term residence. Outside the limited situations above, Medicare 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 a Medicare Advantage plan change the answer?

No. Once hospice starts, Original Medicare covers the hospice care, and it does not pay room and board. The plan can still provide extras such as dental or vision, so ask whether it has any benefit for residential costs.

Does she have to leave the nursing home to get hospice?

Usually not. Hospice can come to her there if the hospice and the home have a written agreement, but a home does not have to work with every hospice, and CMS says a nursing home is not required to offer hospice at all. If it has no agreement with any hospice, it may sign one or, if she wishes, must help her transfer to a place that provides hospice. Ask which hospices it works with before she elects. See coordinating hospice with a nursing home.

Can the nursing home make her leave if we can't pay?

Nonpayment can be a valid reason after proper notice, with appeal rights, but choosing hospice is not. CMS says a resident cannot be discharged for nonpayment while a Medicaid decision is pending, though the home may still charge her during that time, and failing to submit the necessary paperwork can count as nonpayment. See can a nursing home discharge a resident who is on hospice.

Would bringing her home avoid the bill?

It would end the nursing home's charge, and hospice can continue at home. But the family then supplies the day-to-day and overnight care, and any Medicaid room payment stops. See can you bring a loved one home from a nursing home on hospice.

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. Medicaid can't fill the gap the same way, because federal rules bar its home- and community-based waivers from paying room and board. See does hospice pay for assisted living or memory care.

Practical next steps

• Ask the nursing home for the room-and-board rate in writing and confirm what continues once hospice is elected.
• Check Medicaid. If your loved one might qualify, ask the facility's business office or a benefits counselor, and ask whether this home has a Medicaid bed.
• Get the division of charges from the hospice. Ask it to 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.

Bottom line: hospice care in a nursing home is covered by Medicare; the nursing-home room and board generally is not. For residents who qualify, Medicaid can pay for the bed. Confirm the split early so the facility bill never comes as a surprise.