Hospice Room and Board: Who Pays?

Under routine home care, hospice does not pay facility room and board. That cost falls to the resident, from their own money or long-term-care insurance, unless Medicaid or, for some veterans, the VA pays it. Hospice pays for care, not for the bed. The two exceptions are short inpatient stays the hospice arranges, where Medicare does cover the room.

Who can pay, payer by payer

Payer	Does it pay room and board?
The resident	Yes, by default, from income, savings or other resources.
Medicare hospice benefit	Only during a short General Inpatient (GIP) or inpatient respite stay the hospice arranges.
Medicare skilled nursing benefit	Only for a limited skilled stay for a condition unrelated to the terminal illness, if its rules are met. See Medicare skilled nursing care for an unrelated injury.
Medicaid	For nursing-home residents who qualify, yes. Federal law sets the payment at no less than 95% of what the state would have paid the home, and the resident generally still contributes a monthly share. Not assisted-living rent.
Long-term-care insurance	If the policy covers that setting and the person meets its benefit triggers, up to its daily limit. See does long-term care insurance cover hospice room and board.
VA	Sometimes. VA says it pays for community nursing home care only if the veteran meets its criteria, which include service-connected status, level of disability and income. See does the VA pay for hospice room and board.
Medigap	No. It helps with hospice drug and respite costs, but Medicare.gov says Medigap doesn't pay for long-term care.
Medicare Advantage	Electing hospice doesn't make it pay. Original Medicare covers hospice care once it starts. The plan can still provide extras such as dental or vision, so ask whether it has any benefit for residential costs.
The hospice	Not from its own Medicare payment. When Medicaid pays, the state usually pays the hospice, and the hospice passes the money to the home.
Adult children or other family	Not just because they are family. See the section below.

Who actually pays, by situation

Setting	Who pays room & board
Private home (routine home care)	No room charge — it's the family's own home
Nursing home (routine home care)	The resident or long-term-care insurance, or Medicaid for residents who qualify
Assisted living or memory care (routine home care)	The resident or long-term-care insurance. Medicaid waivers can't pay the room and board
Hospice house, living there at the routine level	The resident or long-term-care insurance, unless a state program helps. See what an inpatient hospice (hospice house) costs
General Inpatient (GIP)	Medicare hospice benefit covers the bed, with no coinsurance
Inpatient respite	Medicare hospice covers the bed (5% coinsurance applies). Not available to someone who already lives in a facility

Costs vary by facility and region.

Why hospice doesn't pay the room

Hospice follows the patient wherever they live — it's a benefit, not a place. When someone receives routine home care (the most common level), Medicare pays the hospice a daily rate for the care team, medications, and equipment for the terminal illness. That rate does not include the cost of housing. So if "home" is a private residence, there's no room charge anyway; but if "home" is a nursing home or assisted living facility, the facility's monthly room-and-board fee continues separately and is not covered by hospice. See what hospice does not cover.

What "room and board" actually means

It helps to separate the two halves of any facility bill. Room and board is the cost of the place itself: the bed and meals, and, in Medicare's description, personal care, help with daily activities, social activities, giving medications, keeping the room clean, and supervising the use of equipment and prescribed therapies. Hospice care is the clinical service layered on top — the nursing visits, the comfort medications for the terminal illness, the durable medical equipment, and the social-work and spiritual support. Medicare's hospice benefit pays for the second category in every setting. It does not pay for the first under routine home care.

The Medicaid path

For a nursing-home resident who qualifies, Medicaid can pay the room and board while Medicare pays for hospice. Federal law requires a state that covers hospice to pay at least 95% of what it would have paid the home. The state usually pays the hospice, and the hospice pays the home. Someone with both programs must elect hospice under both at once. See does Medicaid cover hospice.

Two limits catch families. The resident still contributes most of their income, after a personal needs allowance (the federal minimum is $30 a month) and other allowed deductions. And the home has to be able to bill Medicaid: CMS says a resident found eligible may have to move to another home if no Medicaid bed is available or the home does not take Medicaid. Rates and eligibility limits are set by each state; see does hospice room and board coverage differ by state.

The two inpatient exceptions

When care shifts to a facility for a short, specific reason, Medicare's hospice benefit does cover the bed:

• General Inpatient (GIP): for pain or symptoms that can't be managed in other settings. The bed is covered for the short stay, with no coinsurance. A breakdown in caregiving at home does not qualify by itself.
• Inpatient respite: a short stay (up to 5 consecutive days at a time) to give a caregiver at home a break, with a coinsurance of 5% of Medicare's respite payment. From day 6, the patient may be charged for room and board. Medicare's manual says respite cannot be provided to someone who already lives in a facility such as a long-term care nursing home.

See GIP vs. inpatient respite: who pays for the bed.

Assisted living vs. nursing home: an important difference

The room-and-board picture isn't identical across facility types. In a nursing home, Medicaid can pay the room for a resident who qualifies. In assisted living, it can't do the same: federal rules bar Medicaid home- and community-based waivers from paying room and board, though a state waiver may pay for some care services there. Families more often shoulder that cost privately. The hospice care itself is the same in both settings, but the housing math differs. See does hospice pay for assisted living or memory care.

Do adult children have to pay?

Not just because they are family. Federal rules bar a nursing home that takes Medicare or Medicaid from requiring a third-party guarantee of payment as a condition of admission or continued stay. A home may ask a representative with legal access to the resident's money to sign a contract to pay from that money, and the rule says that does not create personal financial liability. Read any "responsible party" paperwork before signing. State family-support laws can change this: Pennsylvania's, for example, makes a spouse, child or parent responsible for financially assisting an indigent relative, with exceptions. If a relative is billed personally, talk with an elder-law attorney or legal aid before paying. These federal rules don't cover assisted living, so read that contract closely too.

What if the money runs out or Medicaid isn't approved yet?

Apply for Medicaid as early as possible. CMS's guidance to nursing-home surveyors says a resident cannot be discharged for nonpayment while a Medicaid decision is pending, that the home should make sure the resident has help with the paperwork, and that switching from the private rate to the Medicaid rate is not nonpayment. The same guidance says the home may still charge the resident while the decision is pending, must refund what it collected for months Medicaid later covers (less the resident's share), and can treat a failure to submit the necessary paperwork as nonpayment. If Medicaid is denied, the resident owes for those days.

Medicaid can also reach back. Federal rules generally let coverage start up to three months before the month of application if the person would have qualified then, but some states limit this under federal waivers. Florida, for example, says the three-month reach-back ended in 2019 for most adults 21 and older, so ask your state before counting on it. For applications made on or after January 1, 2027, a new federal law limits that to two months, or one month for adults in the Medicaid expansion group. See can a nursing home discharge a resident who is on hospice.

Questions to ask before you enroll in a facility

Because the room cost is the part hospice does not cover, clarify it up front so there are no surprises:

• What is the exact monthly room-and-board charge, in writing, and what does it include?
• Does this home take Medicaid, and is a Medicaid bed available? Confirm how the room would be paid on hospice with the state Medicaid program, not just the facility.
• Which hospice agencies already serve this facility, and can we choose our own Medicare-certified hospice?
• How are GIP stays handled here if a symptom crisis happens?
• Will the room be held if my loved one needs a short inpatient stay elsewhere, and what would that cost?

The misconception, corrected

A costly misunderstanding is assuming the benefit pays the nursing-home or assisted-living rent. It doesn't, under routine home care. Families sometimes enroll expecting the facility bill to vanish and are blindsided when it keeps coming. The accurate rule: hospice covers the care delivered in the facility, but the room remains a private cost unless Medicaid, long-term-care insurance or the VA pays it — or unless the patient is in a short GIP or respite stay.

Frequently asked questions

If my mom moves onto hospice in her nursing home, does the monthly bill stop?

No. Under routine home care the nursing-home room-and-board bill continues. Hospice covers the clinical care delivered there, not the room. Medicaid can cover the room if she qualifies.

Does the hospice pay the nursing home?

Only as a pass-through. When Medicaid pays, the state usually pays the hospice and the hospice pays the home. A resident paying privately pays the home directly. For a GIP or respite stay in a facility the hospice contracts with, Medicare pays the hospice and the hospice arranges the stay under a written agreement.

Why can assisted living leave a family paying more than a nursing home?

For someone with few resources, it can because Medicaid can pay nursing-home room and board but not assisted-living room and board. The hospice care is the same; the housing coverage differs. For someone paying privately, compare the two actual rates.

Is there a copay for the respite bed?

There's a coinsurance of 5% of Medicare's payment for a respite day, and your total for a coinsurance period can't exceed the Part A inpatient hospital deductible. There is no patient charge for the bed during a GIP stay.

How much is facility room and board?

Each facility sets its own price, and it varies widely by facility and region. A nursing home may charge non-Medicaid residents any amount unless state law limits it. The federal long-term care site lists 2016 national averages of $225 a day for a semi-private nursing-home room and $119 a day for a one-bedroom assisted-living unit. Those figures are a decade old, so don't budget from them. Get the current amount in writing from the facility before enrolling.

Will the room be held during a hospital stay?

Ask before the move. Before a hospital transfer, a nursing home must give written notice of the state's bed-hold policy and its own. Whether Medicaid pays to reserve the bed depends on the state. If the stay runs past the bed-hold period, a resident who still needs the care and is eligible for Medicaid nursing-facility or Medicare skilled nursing services returns to the previous room if available, or to the first available semi-private bed. The rule is written for hospital stays and therapeutic leave, so if a GIP stay is in a hospice unit, ask how the home treats it.

Can room and board be deducted on taxes?

Sometimes. IRS Publication 502 says you can include nursing-home care as a medical expense for yourself, your spouse or your dependents, including meals and lodging, if a principal reason for being there is to get medical care. If the reason is personal, only the medical or nursing part counts. Ask a tax professional how this applies to you.

Do we owe the rest of the month after a death?

Not at a certified nursing home. Federal rules say that if a resident dies, the home must refund any deposit or charges already paid, less its daily rate for the days the resident lived there or held a bed, regardless of any minimum-stay or notice terms, and must pay it within 30 days. In assisted living, check the contract and your state's rules.

Practical next steps

• Get the room-and-board figure in writing from the facility before enrolling.
• Check Medicaid: if your loved one has Medicaid or might qualify, ask the state program how the nursing-home bed is paid on hospice, and start any application early.
• Ask the hospice intake team to walk through exactly what's covered in your specific setting.
• Understand the inpatient exceptions so you know when the bed is covered.
• Compare agencies at hospices near you using CMS Care Compare scores.

Bottom line: hospice pays for care, not for the room under routine home care. Plan on the resident paying facility room and board, unless Medicaid, long-term-care insurance or the VA pays it, or the patient is in a short GIP or respite stay.