Paying for care
Who pays for the nursing home when you are on hospice?
Medicare pays the hospice for hospice care when a person lives in a nursing facility. It pays nothing toward room and board. The bed, meals and daily facility care are paid by the resident or family, by long-term care insurance, or by Medi-Cal for residents who are eligible. In California, a Medi-Cal managed care plan pays the room and board to the hospice, and the hospice pays the facility under a written agreement.
Reviewed by our medical director, October 12, 2026
On this page (7 sections)
What Medicare pays when a hospice patient lives in a nursing facility
When a person on hospice lives in a nursing facility, Medicare pays the hospice its routine home care rate. That is the same daily rate it pays when a person lives in a private home (42 CFR 418.302). The facility is the person's home. The hospice team visits there, brings medicines, equipment and supplies for the terminal illness, and works with the facility staff.
Medicare pays nothing toward the room and board. The hospice benefit has never included a place to live. The one exception is a short stay the hospice itself arranges. General inpatient care is provided only when medically necessary during a symptom crisis, and respite care is up to 5 days at a time. Both are part of the hospice benefit. See levels of care.
A nursing facility and a hospice need a written agreement before the hospice can care for residents there (42 CFR 418.112). The agreement says who does what, how the two teams share information, and how the facility is paid for room and board when Medi-Cal covers it. We care for people wherever they call home, including nursing facilities, residential care facilities for the elderly (RCFEs) and board-and-care homes, in coordination with facility staff.
Who pays what in a nursing facility
| Cost | Who pays | What to know |
|---|---|---|
| Hospice care: nurse, aide, social worker and chaplain visits, equipment and supplies for the terminal illness | Medicare, Medi-Cal or your health plan pays the hospice | Under Medicare, most people pay nothing for hospice care itself. The facility does not bill you for the hospice team |
| Room and board when you pay privately | The resident or family, or long-term care insurance if the policy covers it | This is the facility's own charge for the bed, meals and daily care. Hospice does not change the rate and does not add to it. Ask the business office for the rate in writing |
| Room and board with Medi-Cal | Medi-Cal, for residents who are eligible for Medi-Cal nursing facility care. In California the managed care plan pays the hospice, and the hospice pays the facility | Any share of cost the resident already pays the facility continues. See Medi-Cal and hospice |
| Medicines related to the terminal illness | The hospice | There can be a copay of up to $5 per prescription under Medicare. The hospice and the facility agree on how medicines are ordered, delivered and stored |
| Care unrelated to the terminal illness | Your regular coverage: Medicare, Medi-Cal or your plan | The usual deductibles, copays and plan rules apply. The hospice doctor and your doctor decide together what is related to the terminal illness and what is not |
This table is general information, not a benefits determination. We verify your benefits with your payer and explain them to you before care starts.
How Medi-Cal pays room and board in California
If the resident has Medi-Cal and is eligible for nursing facility care, Medi-Cal keeps paying the room and board after the person elects hospice. Most Medi-Cal members in California are in a managed care plan. DHCS All Plan Letter 25-008, issued in 2025, directs those plans to pay the nursing facility room and board for a member on hospice directly to the hospice. The hospice then pays the nursing facility under their written agreement.
For the family, this should not create a new bill. The resident keeps paying any share of cost already owed to the facility. We bill the plan and pay the facility. Tell us at the first call that the person has Medi-Cal, and have the plan card and the Medi-Cal card ready.
If the person has both Medicare and Medi-Cal, Medicare pays for the hospice care and Medi-Cal pays the room and board. The two do not overlap.
About the claim that families owe about $10,000 a month
A claim that spread online in 2026 says a family on hospice owes about $10,000 a month. That figure describes what a nursing facility may charge a private-pay resident for room and board. It is not a hospice charge. Hospice does not bill a family for the bed, and choosing hospice does not raise the facility's rate.
If someone tells you hospice costs that much, ask what the number is for. If it is the facility's monthly rate, the questions that matter are whether long-term care insurance applies and whether the person may be eligible for Medi-Cal. Our social worker can help with both. See paying for care.
How to find out what you will pay
- Step 1
Ask the facility's business office for the room and board rate in writing
Ask whether the rate changes when a resident is on hospice. Under the Medicare rules it should not.
- Step 2
Tell the hospice about every kind of coverage
Medicare, Medi-Cal, a managed care plan, long-term care insurance or a VA benefit. We check each one with the payer.
- Step 3
Ask about Medi-Cal if money is tight
Many people living in a nursing facility become eligible for Medi-Cal nursing facility coverage. A hospice social worker can explain how to apply through the county.
- Step 4
Get the answer before care starts
We tell you what is covered, what is not and what you may owe, including room and board, before anyone signs anything.
Common questions
Does Medicare pay for a nursing home if I am on hospice?
No. Medicare pays the hospice for hospice care. It does not pay the nursing facility room and board. Medicare's short skilled nursing facility benefit after a hospital stay is a different benefit, and it does not pay long-term room and board. The room and board is paid by the resident or family, long-term care insurance, or Medi-Cal for residents who are eligible.
Can I stay in my nursing home and start hospice?
In most cases, yes. Hospice comes to the person. The facility staff continue the daily care, and the hospice team adds its visits, medicines, equipment and a nurse by phone at any hour. The facility and the hospice need a written agreement first. Many facilities already have one with several hospices.
Who do I ask about Medi-Cal paying room and board?
Start with the facility's business office and the hospice. The business office knows whether the resident has Medi-Cal nursing facility coverage and what share of cost applies. The hospice bills the Medi-Cal managed care plan and pays the facility under their agreement. If the person does not have Medi-Cal yet, the county social services office handles applications, and a hospice social worker can point you to it.
What if the nursing home says it does not work with my hospice?
You have the right to choose your hospice. A facility may limit the hospices it has agreements with, because every hospice needs a written agreement with the facility before it can serve residents there. Ask early which hospices the facility works with, and ask whether it will sign an agreement with the hospice you want. If you work at a facility and want to set one up, see hospice in skilled nursing facilities.
Read more
The fuller pages: paying for care, Medi-Cal and hospice, hospice with a Medicare Advantage plan and where care happens.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- October 12, 2026
- Next review
- April 12, 2027
How we write and review this site
Sources
- Medicare.gov: Hospice care coverage (opens in a new tab)
- 42 CFR 418.302: Payment procedures for hospice care (opens in a new tab)
- 42 CFR 418.112: Hospices that provide care to residents of a SNF/NF or ICF/IID (opens in a new tab)
- DHCS All Plan Letter 25-008: Hospice services and Medi-Cal managed care (2025) (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (844) 646-4434 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice