Hospice in a Nursing Home: Who Pays?

In a nursing home, assisted living, or memory care, Medicare's hospice benefit pays for the hospice care itself: the nurses, aides, medicines for the terminal illness, equipment, and emotional support. It does not pay the room and board, which is the facility's cost of living there. That residential bill stays with the resident, paid privately, by long-term-care insurance, or by Medicaid for those who qualify (Medicare.gov).

This split blindsides a lot of families, so it helps to see it clearly before the first invoice arrives. The hospice care is almost always fully covered. The cost of the room is a separate question with a few possible answers, and you can ask for both in writing up front.

Hospice can come to wherever your person lives

You do not have to move a loved one home to start hospice. According to Medicare, you can usually get Medicare-approved hospice care in your home or another facility where you live, like an assisted living facility or a nursing home. The hospice team travels to the resident, working alongside the facility's own staff to manage comfort, symptoms, and support for the family.

That is true whether your person is in a skilled nursing facility, an assisted living community, or a memory care unit. Choosing hospice there means the care shifts toward comfort for the terminal illness rather than trying to cure it, according to a CMS overview of the Medicaid hospice benefit. It can begin without uprooting anyone from a room and a routine they know. If you are still weighing the move to comfort care, when to call hospice walks through the signs.

What the Medicare hospice benefit pays for, and what it does not

The confusing part is that two different bills arrive from the same building. One is for the hospice care. The other is for living there. Medicare's hospice benefit handles the first and not the second.

For the covered hospice care, your out-of-pocket cost is very small. You pay nothing for hospice care from a Medicare-approved hospice provider, aside from a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management (Medicare.gov). What Medicare's hospice benefit does not cover is room and board. As the Medicare Hospice Benefits booklet puts it plainly, "Your hospice benefit doesn't cover room and board." Medicare says the same about where you live: it does not cover room and board if you get hospice care in your home or if you live in a nursing home (Medicare.gov).

As of July 2026, here is the split:

Medicare hospice benefit pays for	Medicare hospice benefit does not pay for
Hospice nurses, aides, social workers, and chaplain visits	Room and board: the facility's daily residential charge
Medicines for the terminal illness (up to a $5 copay per prescription)	Ongoing rent, meals, and personal-care fees the facility bills
Medical equipment and supplies related to the illness	Long-term custodial living costs at a nursing home or assisted living
24-hour on-call support and the levels of hospice care	(Exception: a short-term inpatient or respite stay the hospice arranges)

The point of the table is simple: the care is covered, the room is not. A charge on the "does not pay" side is not a gap in your person's care; it is just the residential cost, which was always going to be there.

Room and board: the cost that stays with the family

So who pays for the room? Because Medicare's hospice benefit leaves room and board out, the residential cost is handled the same way it was before hospice began. In practice there are three common answers, and often a combination:

• Private pay. The resident or family pays the facility's monthly rate directly, from savings, income, or the sale of a home. This is the most common route in assisted living and memory care.
• Long-term-care insurance. If your person has a long-term-care policy, it may pay some or all of the facility's daily rate. Check the policy's benefit amount and any waiting period before it starts.
• Medicaid, for those who qualify. Medicaid is a joint federal and state program for people with limited income and assets, and its rules vary by state.

Medicaid is where an important protection lives. Hospice care is itself a Medicaid benefit for terminally ill patients who qualify, according to the CMS Hospice Benefit Toolkit. And when a Medicaid-eligible person who lives in a nursing facility elects hospice, federal law directs the state to pay the facility an additional room-and-board amount, set at least 95 percent of the daily rate Medicaid would otherwise have paid that facility for that resident (42 U.S.C. 1396a). A companion section confirms that this special payment applies when a hospice-eligible person resides in a nursing facility (42 U.S.C. 1396d). In plain terms: for a dually eligible resident (someone who has both Medicare and Medicaid) in a nursing facility, Medicaid can pick up the room-and-board rate the hospice benefit does not.

Two cautions. First, this room-and-board pass-through is tied to Medicaid eligibility and to a nursing facility; it is not automatic, and assisted living is often treated differently. Second, each state sets its own Medicaid rules, including the life-expectancy threshold a doctor must certify to elect the benefit (CMS fact sheet). Confirm what your state's Medicaid actually covers with the facility's business office and the hospice before you count on it.

The one exception: short-term inpatient and respite care

There is one situation where Medicare does pay for a facility stay. If the hospice team determines that your person needs short-term inpatient or respite care services that they arrange, Medicare will cover the stay in the facility (Medicare.gov). This is the exception that proves the rule: the coverage flows because the hospice arranged it as a level of hospice care, not as ordinary room and board.

Respite care is the version most families use. It is a short, occasional inpatient stay in a Medicare-approved facility, such as a hospice inpatient unit, a hospital, or a nursing home, meant to give an exhausted family caregiver a few days to rest. You can stay up to 5 days each time you get respite care, and you may owe a small copayment of about 5 percent of the Medicare-approved amount (CMS booklet). Medicare's own example: if it approves $100 a day for inpatient respite, you would pay about $5 a day. Outside of these hospice-arranged stays, though, the residential room and board is yours to arrange.

Get the costs in writing before you enroll

The families who avoid a nasty surprise are the ones who ask two plain questions early, one to each party:

1. Ask the facility: What is the monthly room-and-board rate, what does it include, and how is it paid (private pay, my long-term-care policy, or Medicaid)? Ask for the number in writing.
2. Ask the hospice: What exactly does the Medicare hospice benefit cover here, and is there anything at all we would pay out of pocket beyond the small drug copay?

Getting both answers on paper, before you sign, turns a stressful unknown into a manageable budget. It also lets you compare honestly, because the hospice care is covered the same way at any Medicare-approved hospice, while facility room-and-board rates differ a lot from one place to the next.

For a fuller picture of what hospice does and does not cost, see how much does hospice cost. If your person does not have Medicare, or you are piecing together coverage for the residential side, paying for hospice without Medicare lays out the other options. You can also confirm the basics of coverage in does Medicare cover hospice.

None of this changes the most important thing: the hospice care your person needs is covered, wherever they live. The room is a separate bill with a clear set of answers, and now you know which questions unlock them.

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