Does Medicare pay for hospice room and board in a nursing home or assisted living?

Families are often relieved to hear hospice is covered in full by Medicare, then caught off guard by the next bill from the nursing home or assisted living community. Both things are true. Medicare pays for hospice care. It does not pay for the place your loved one lives.

The rule in one sentence

Medicare’s hospice benefit covers the hospice team, medications for comfort, equipment and supplies related to the terminal illness, but it does not cover room and board, whether home is a house, an assisted living apartment or a nursing home bed. The exception is a short inpatient stay that the hospice team arranges, either for symptoms that cannot be managed where your loved one lives or to give a caregiver respite.

Who pays for the room, setting by setting

Hospice in a nursing home

Many people receive hospice right where they already live, in a nursing home. The hospice team visits and works alongside the nursing home staff, and the nursing home keeps providing daily care and the room.

For residents who qualify for Medicaid, Medicaid continues to pay room and board. In Utah, Medicaid’s state plan sets that payment at 95 percent of what Medicaid would have paid the nursing facility, with the money routed through the hospice. For a family, the practical effect is that a Medicaid-eligible resident’s room is still covered after they choose hospice, subject to the usual Medicaid rules about the resident’s share of cost.

One thing changes. A short Medicare skilled nursing stay and hospice for the same terminal condition do not go together, because the hospice now manages care for that illness. If a short-term rehab stay is being discussed, ask the hospice and the nursing home how it would affect coverage before deciding.

Hospice in assisted living

Assisted living residents can receive hospice in their apartment, and many communities welcome it. Medicaid generally does not pay for assisted living room and board, so the monthly rent continues as before from the resident’s own funds, long-term care insurance, or benefits like VA pension with Aid and Attendance. Some communities may adjust their care fee if the hospice aide is now handling some personal care; it is worth asking.

Hospice houses and inpatient units

A hospice house or inpatient unit may provide two very different levels of care. General inpatient care is intensive, short-term care for pain or symptoms that cannot be managed elsewhere; Medicare covers it, room included. If a patient stays in a hospice house at the routine level because home is no longer workable, the facility usually charges a daily room and board fee. Ask for the rate in writing.

Questions for the facility’s business office

• Will our monthly charge change at all once hospice starts?
• If my loved one is on Medicaid, how will room and board be billed now, and will their share of cost change?
• If we are paying privately and savings run low, do you accept Medicaid, and how long does approval usually take here?
• Which hospices do you already work with?

Why this catches families off guard

The word “covered” does a lot of work. When a hospice says its care is covered by Medicare, that is true, and it is a real help: nurses, aides, medications for comfort and equipment can be worth a great deal. But in a nursing home or assisted living, the largest bill each month is usually the room, meals and daily care, and that bill does not go away. Asking early lets you plan instead of scramble.

What to do next

1. Ask the hospice: “Which level of care will my loved one receive, and who pays for the room at that level?”
2. If your loved one is in a nursing home, ask the business office whether they are on Medicaid or may qualify soon.
3. In assisted living, ask whether hospice changes the care fee.
4. Read what families pay out of pocket for hospice for the other costs to plan for.

Common questions

Does Medicare pay for hospice in a nursing home?

It pays for the hospice care, not the nursing home room and board. Medicaid may cover room and board for residents who qualify.

Does Medicare pay for a hospice house?

Medicare pays for the hospice care in a hospice house. It also covers the room during a short general inpatient or respite stay arranged by the hospice. For a longer stay at the routine level, the family usually pays room and board.

How do people pay for hospice room and board?

With the same sources that paid before hospice: income and savings, long-term care insurance, Medicaid in a nursing home, or VA benefits for eligible veterans and surviving spouses.

Does Medicare pay for hospice care in an assisted living facility?

Yes, for the hospice services. The assisted living rent and care fees are not covered.