Hospice Billing: What the Bills Actually Mean

Under Medicare, a hospice is paid a daily rate based on the level of care the patient is receiving, and that payment goes from Medicare to the hospice, not to you. Families usually owe nothing for hospice services. The bills that actually reach you are typically a facility's separate room-and-board charge, a small drug copay or respite coinsurance, and normal cost-sharing for doctors and care outside the hospice benefit.

How hospice gets paid: per day, by level of care

Medicare pays the hospice a fixed daily amount for each day the patient is in its care, tied to which of the four levels of care applies that day (42 CFR 418.302):

• Routine Home Care: the standard level, wherever the patient lives. Medicare pays a higher rate for days 1-60 of the hospice election and a lower rate from day 61 on.
• Continuous Home Care: brief crisis periods at home with at least 8 hours of care in a day, predominantly nursing, paid by the hour.
• General Inpatient Care (GIP): symptoms that cannot be managed at home, handled in a facility.
• Inpatient Respite: a short facility stay, up to 5 consecutive days at a time, to relieve the caregiver.

On routine home care days in the last 7 days of life, Medicare also pays a "service intensity add-on" for in-person care by a registered nurse or social worker, up to 4 hours a day. The family does not see a per-day invoice for any of this. For what each level means, see the 4 levels of hospice care explained.

What you might actually be billed

• A Medicare Summary Notice (MSN) or plan Explanation of Benefits (EOB), not a bill. With Original Medicare you get an MSN listing what was billed and paid; Medicare says plainly that it is not a bill. Other plans send an EOB.
• A drug copay of up to $5 per prescription for outpatient drugs for pain and symptom management.
• Inpatient respite coinsurance: 5% of the Medicare-approved amount per respite day. Your total respite coinsurance cannot exceed the year's Medicare inpatient hospital deductible. See hospice copays and coinsurance under Medicare.
• Facility room and board: the hospice benefit does not cover room and board, so a nursing home, assisted-living community or hospice residence bills it separately. The exception is a short general inpatient stay or a respite stay the hospice arranges. Respite is covered for up to 5 days in a row, and you may owe room and board from day 6.
• Doctor and other non-hospice bills: see the next section.

How doctors bill for hospice patients

Who sends the doctor's bill depends on the doctor's relationship to the hospice:

Doctor or service	Who bills Medicare	What you may owe
Hospice medical director and team physician oversight (care planning, supervision)	Included in the hospice's daily rate	Nothing
Other services by a physician employed by or under contract with the hospice	The hospice, on its own claim; paid at 100% of the Medicare physician fee schedule	Nothing
Your own attending doctor, NP, or PA (not employed by the hospice) treating the terminal illness	The doctor, under Part B, with modifier GV	Normal Part B deductible and coinsurance apply
Any provider treating a condition unrelated to the terminal illness	That provider, under regular Medicare, with modifier GW (or condition code 07 on facility claims)	Normal Medicare cost-sharing
Another provider treating the terminal illness without hospice arrangement	Medicare denies the claim; it must go through the hospice	Possibly the full cost; ask the hospice first

Sources: 42 CFR 418.304; Medicare Claims Processing Manual, Ch. 11, §§40.1.3, 40.2 and 50. Medicare denies a professional claim for a hospice patient that carries neither the GV nor the GW modifier, so a doctor's office may need to rebill. Medicare's hospice booklet advises contacting the hospice team before getting hospital, emergency, or ambulance care, or you might have to pay the full cost. More: do you pay anything to keep your own doctor on hospice.

The non-covered items list (required from October 1, 2026)

For hospice elections beginning on or after October 1, 2026, every hospice must give the patient or representative a written addendum titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" within the first 5 days of the election's effective date, and update it within 3 days when the plan of care changes those decisions (42 CFR 418.24(c)-(d)). It lists the conditions, items, services, and drugs the hospice has decided are unrelated to the terminal illness, with a plain-language explanation. Anything on that list is billed outside the hospice, through regular Medicare, Part D, or your plan, so keep it with your billing papers and share it with your other providers.

How the hospice's own billing works

For the curious, and for anyone working through "hospice billing" from the agency side:

• Notice of Election: the hospice must file it with its Medicare contractor within 5 calendar days after the effective date of the election. If it files late, Medicare does not pay for the days before filing, and the hospice may not bill the patient for them (42 CFR 418.24(e)).
• Monthly claims: hospices bill Medicare on an institutional claim (type of bill 081x or 082x), one claim per calendar month per patient.
• What a hospice may charge you for covered hospice care: only the drug copay and respite coinsurance described above (42 CFR 418.400 and 418.402; Medicare Benefit Policy Manual, Ch. 9, §30). Room and board is not covered, so a hospice that runs a residential hospice house can bill it, and so can a facility for respite days after the fifth in a row (Ch. 9, §40.2.2).

A line-by-line tour of a hospice MSN or EOB

The statement can look frightening because it lists large daily charges, but each part has a plain meaning. The provider line names the hospice. The service dates show the period being reported, usually a calendar month. The amount charged is what the hospice submitted; the Medicare-approved amount is what Medicare recognizes; Medicare paid is what went to the hospice. The line that matters to you is "Maximum You May Be Billed" (or "your responsibility" on a plan EOB). For hospice services it is usually $0; a non-zero amount is typically the drug copay or respite coinsurance.

Bill or not a bill? A quick reference

What you received	Is it a bill?	What to do
Medicare Summary Notice or plan EOB	No	File it; check the "Maximum You May Be Billed" line
Hospice drug copay (up to $5/Rx)	Yes, small	Ask whether the hospice charges it; Medigap may cover it
Inpatient respite coinsurance (5%)	Yes, small	Confirm the respite stay occurred
Bill from your own doctor	Yes	Normal Part B cost-sharing; check it was coded as a hospice patient
Facility room-and-board statement	Yes	Separate obligation; check Medicaid or long-term care insurance
A charge for the hospice nurse, aide, equipment, or comfort drugs	Should not happen	Call the hospice billing office to correct

What to do if a bill looks wrong

If a statement charges you for something the hospice should cover, such as nurse visits, comfort medications for the terminal illness, or the hospital bed and oxygen the team delivered, call the hospice billing office first; most issues are coding mistakes. To dispute a Medicare decision, the last page of your Medicare Summary Notice gives step-by-step appeal directions, or call 1-800-MEDICARE (1-800-633-4227). For concerns about the quality of hospice care, your hospice must give you contact information for your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Keep notes of who you spoke with and when, and confirm before paying: an unnecessary payment can be hard to get back.

Frequently asked questions

Why does my statement show thousands of dollars?

That is the daily rate Medicare pays the hospice, summed over the billing period. It is Medicare's payment to the agency, not a charge to you. Check the "Maximum You May Be Billed" line.

How do physicians bill for hospice patients?

Hospice-employed or contracted physicians are billed by the hospice and cost you nothing. Your own attending doctor bills Medicare Part B with modifier GV, and normal Part B cost-sharing applies. Care for unrelated conditions is billed with modifier GW under regular Medicare.

Will I get a separate bill for medications?

For drugs for pain and symptom management, the most you owe is up to $5 per prescription. Drugs unrelated to the terminal illness are not covered by hospice and may be covered by your Part D plan.

I'm in a Medicare Advantage plan. Who pays the hospice?

Original Medicare covers everything related to the terminal illness once hospice starts, even if you stay in your Medicare Advantage plan. The plan can still cover unrelated care and extra benefits if you keep paying its premiums. See does Medicare Advantage cover hospice.

Does Medigap help with hospice bills?

Yes. Medicare's hospice booklet says a Medigap policy covers hospice costs for drugs and respite care, and helps with costs for problems unrelated to the terminal illness.

Is the facility room-and-board bill negotiable?

The charge is set by the facility, but who pays it can change: Medicaid may cover nursing-home room and board for people who qualify, and a long-term care policy may help. See hospice room and board: who pays.

Practical next steps

• Keep, but do not pay, MSNs and EOBs until you confirm whether anything is owed.
• Keep the non-covered items addendum with your billing papers.
• Ask the hospice billing office to explain any statement and whether it charges the drug copay.
• Separate the facility bill from the hospice's billing, and check whether Medicaid or a long-term care policy can cover room and board.
• Verify coverage up front with does Medicare cover hospice care, then compare hospices near you.