Hospice care is a specialized approach focused on comfort and quality of life for individuals facing a terminal illness. This type of care manages symptoms and provides emotional and spiritual support when curative treatment is no longer the goal. While the medical and support services provided by a hospice agency are typically covered by insurance, families often encounter unexpected costs related to where the patient lives. Understanding the difference between covered medical services and the non-covered expense of “room and board” is a frequent challenge.
Covered Services Versus Non-Covered Living Costs
The distinction between covered hospice services and out-of-pocket expenses centers on the nature of the cost. The core hospice benefit, established under Title XVIII of the Social Security Act, comprehensively covers the medical and support services required for the terminal illness. This includes nursing care, physician services, medical equipment, medications for symptom control, and social work services, all of which are paid for by Medicare, Medicaid, or private insurance.
However, the benefit generally does not cover the cost of daily living, which is categorized as room and board. This expense covers the patient’s lodging, utilities, meals, and non-medical personal care, which are costs the individual would incur regardless of their hospice enrollment status. Medicare explicitly excludes long-term room and board from its hospice coverage, making it a direct financial responsibility for the patient or their family.
Daily Costs in Different Care Settings
The actual cost of room and board is entirely dependent on the physical location where the patient receives care.
Private Residence
If the patient remains in their private residence, the room and board cost is effectively zero, as the patient continues to pay their usual household expenses. Families may, however, see increased costs for non-medical services, such as hiring private-duty aides or companions, which are separate from the hospice aide services and are not covered by the hospice benefit.
Residential Facilities
When care is provided in a residential or long-term care facility, such as an assisted living center or a nursing home, the patient is responsible for paying the facility’s daily room and board rate. The hospice agency pays for the medical and nursing services related to the terminal illness, but the patient pays the facility for their place of residence. These out-of-pocket residential rates can vary significantly, often falling into a range between $250 and $700 per day, depending on the facility type and geographic location.
Inpatient Hospice Units
In a dedicated inpatient hospice unit, the cost structure changes based on the reason for the stay. If a patient requires short-term admission for acute symptom management or uncontrolled pain, this is classified as General Inpatient Care (GIP), and Medicare covers the room and board because the stay is considered medically necessary. Similarly, short-term Inpatient Respite Care (IRC) for the primary caregiver, limited to five consecutive days, is also covered by Medicare, though a small copayment may apply. If a patient remains in a dedicated hospice facility for a long-term stay solely for convenience, rather than for acute medical need, the facility will transition the billing to a residential rate. This residential rate, which must be paid out-of-pocket, typically falls within the same $250 to $700 per day range seen in other long-term care settings.
Strategies for Covering Room and Board Expenses
Families have several avenues for covering the non-covered room and board costs, with eligibility often tied to financial need and service history.
Medicaid
Medicaid, authorized under Title XIX of the Social Security Act, frequently covers the room and board expense for eligible patients residing in a nursing facility or residential hospice setting. When a patient is dually eligible for Medicare and Medicaid, the state Medicaid agency will pay the hospice provider a daily amount, often 95% of the skilled nursing facility rate, which the hospice then passes through to the facility.
Veterans Benefits
Veterans who are enrolled in the Veterans Health Administration (VA) also have specific coverage options that may assist with facility costs. While the VA’s standard benefits package covers hospice medical care in the community, it generally does not cover routine room and board in private facilities. However, if the patient receives care within a VA facility or a community facility with a specific VA contract, the room and board costs may be covered as part of the benefit.
Private Funding and Assistance
For patients without Medicaid or VA eligibility, private funds and long-term care insurance policies become the primary resources. Long-term care insurance may cover the residential component of care, but policy details must be carefully reviewed, as some plans exclude or limit coverage for hospice residential stays. Additionally, many non-profit hospice organizations offer charitable assistance or operate with a sliding scale fee structure to help cover room and board costs for patients who face significant financial hardship.