GIP vs. Inpatient Respite: Who Pays for the Bed?

In both General Inpatient (GIP) care and inpatient respite care, the Medicare hospice benefit pays for the bed. The difference is what the family owes: GIP has no room charge and no coinsurance, while inpatient respite carries a coinsurance of 5% of Medicare’s payment for each respite day, for up to 5 days in a row. That is unlike Routine Home Care, where Medicare does not cover room and board in a nursing home or other residence.

What is a GIP bed?

A “GIP bed” is an inpatient bed where a hospice provides general inpatient care: short-term, round-the-clock care for pain or symptoms that cannot be managed at home or in another setting. Federal rules (42 CFR 418.108) require it to be in a hospice’s own inpatient unit, or in a Medicare-certified hospital or skilled nursing facility that meets the hospice standards for 24-hour nursing. Medicare pays the hospice a single daily GIP rate that covers the stay, bed included. From October 1, 2026 through September 30, 2027 the national base rate is $1,231.51 a day, adjusted for local wages. When the bed is in a hospital or nursing facility the hospice contracts with, the hospice arranges the stay under a written agreement with that facility.

Why these two levels are different

Hospice has four levels of care, and these two are the inpatient ones. They look similar, since the patient is in a facility rather than at home, but they exist for very different reasons.

General Inpatient (GIP): crisis care

GIP is for a genuine medical crisis. If symptoms can’t be controlled at home, the hospice moves the patient to a hospital, hospice inpatient unit, or skilled nursing facility for intensive, short-term care until things stabilize. Medicare’s manual also lists medication adjustment, observation, and other stabilizing treatment as appropriate reasons. Because it is paid as its own level of hospice care, there is no room-and-board charge to the family. Learn more in what is General Inpatient hospice care.

Inpatient respite: caregiver relief

Respite is about the caregiver, not a new crisis. The patient is stable, but the people caring for them at home need rest, for example to recover, travel to a family event, or deal with their own illness. Medicare covers the stay for up to 5 consecutive days at a time, on an occasional basis, with a 5% coinsurance. See is there a copay for inpatient respite care and what is respite care in hospice.

How much does inpatient respite cost the family?

• Per day: 5% of what Medicare pays the hospice for a respite day. The national base respite rate for October 2026 through September 2027 is $545.93 a day, so the coinsurance is about $27.30 a day, or about $136.50 for 5 days, before the adjustment for local wages. Ask your hospice for the exact figure in your area.
• Cap: Your total respite coinsurance cannot exceed the Part A inpatient hospital deductible for the year your hospice coinsurance period began ($1,736 in 2026). That period starts when your hospice election takes effect and ends only after 14 days in a row without an election in effect.
• Day 6 and beyond: Medicare pays the hospice only the Routine Home Care rate for extra respite days, and the family may be charged for room and board from day 6 on.
• Drugs: The hospice drug copay (up to $5 per prescription) applies only to drugs given while the patient is not an inpatient.

Why “who pays the bed” is different from Routine Home Care

The reason this question matters at all is that the everyday level of hospice, Routine Home Care, works differently. Under Routine Home Care, Medicare pays the hospice for its services wherever the patient lives, but it does not pay room and board if the patient lives in a nursing home or assisted living. GIP and inpatient respite are the two levels where that flips: Medicare covers the facility stay when the hospice team arranges short-term inpatient or respite care. The key idea is that the bed is covered when the stay is the care, not when the facility is simply where the person lives.

How a stay gets authorized and billed

Families don’t choose a level of care off a menu; the hospice determines it based on need, and that determination drives who pays. A few practical points:

• GIP must be clinically justified. The hospice team documents the pain or symptoms that cannot be managed elsewhere. When the crisis resolves, the patient steps back down to Routine Home Care, so GIP is not open-ended.
• Respite is requested for the caregiver. You can ask the social worker to arrange it when you are exhausted. It does not require a medical crisis, and Medicare covers up to 5 consecutive days at a time.
• Get the level in writing. Ask the hospice to confirm which level any facility stay will be billed under, so a respite coinsurance, a room-and-board charge after day 5, or a step-down to Routine Home Care doesn’t surprise you.

The misconception to correct

Families often blur these two together or assume any facility stay on hospice is the same. The key distinction: GIP is for symptoms; respite is for the family. Medicare’s manual says GIP is not appropriate just because caregiver support at home has broken down, unless the patient also meets the GIP symptom standard, and respite is not meant for managing an uncontrolled crisis. Using the right level matters because it affects both the care the patient receives and what, if anything, you pay. Neither level is a long-term residential stay, where Medicare does not pay for the bed at all.

Where these stays happen

GIP must be provided where round-the-clock nursing is available: a hospital, a hospice’s own inpatient unit (often called a “hospice house”), or a skilled nursing facility that meets the hospice 24-hour nursing standards. Respite can be provided in any of those settings or in a Medicare- or Medicaid-certified nursing facility that meets the hospice standards for patient areas and provides 24-hour nursing. When you are comparing hospices, ask whether the agency runs its own inpatient unit or relies on contracts, and how quickly it can place a patient for either level. None of this changes the payment rules, but it does affect how smoothly a stay can be set up.

A decision guide for the moment it matters

When something changes, ask yourself: is this about the patient’s symptoms, or about the caregiver’s capacity?

• If symptoms are out of control (severe pain, breathing distress, agitation that home measures aren’t fixing), call the hospice’s 24/7 line and ask about GIP. No room charge applies.
• If the patient is stable at home but you are depleted, ask the social worker about respite. Expect the 5% coinsurance and the 5-day limit.
• If the patient lives in a facility and nothing acute is happening, that is Routine Home Care. Medicare does not cover the room and board, and respite is not available to facility residents.

Frequently asked questions

Does GIP cost the family anything?

No room-and-board charge and no coinsurance apply to GIP, because it is a level of hospice care paid by the Medicare hospice benefit. The hospice drug copay applies only to drugs given while the patient is not an inpatient.

How much is the respite coinsurance?

5% of Medicare’s payment for each respite day, which works out to roughly $27 a day at the national base rate before local wage adjustment. Your total respite coinsurance is capped at the Part A inpatient hospital deductible ($1,736 in 2026). Ask the hospice for an estimate before the stay.

Can we use respite more than once?

Yes, but Medicare describes respite as occasional, and each stay is limited to 5 consecutive days. Ask your hospice how it handles repeat requests.

What if respite lasts longer than 5 days?

From day 6, Medicare pays the hospice only the Routine Home Care rate, and the family may be billed for room and board for those extra days.

Can a nursing home resident get respite?

No. Medicare’s manual says respite cannot be provided to hospice patients who live in a facility such as a long-term care nursing facility.

What if my loved one’s symptoms flare during a respite stay?

If a true crisis develops, the hospice can reassess and move the patient to GIP-level care, which is billed differently and has no coinsurance. Call the hospice team right away rather than waiting.

Is a hospice house stay always GIP?

No. A patient can be in a hospice house under different levels: GIP for a crisis, respite for a caregiver break, or Routine Home Care if they live there. The level, not the building, determines who pays for the bed.

Practical next steps

• If symptoms are out of control, call the hospice’s 24/7 line and ask whether GIP is appropriate; don’t wait it out at home.
• If you’re exhausted, ask the social worker to arrange respite and request an estimate of the 5% coinsurance.
• Confirm in writing which level any facility stay will be billed under, so there are no surprises.
• Still choosing a provider? Compare hospices near you and ask how quickly they can arrange GIP and respite.

If hospice hasn’t started yet, ask for a hospice evaluation; the team determines the right level of care based on the patient’s clinical needs.