Who Pays for Hospice Room and Board?

Hospice care offers a philosophy of comfort and quality of life for individuals facing a life-limiting illness. This specialized approach focuses on managing symptoms and providing supportive services rather than pursuing curative treatments. While many medical services within hospice care are typically covered by various insurance programs, the financial responsibility for “room and board” often has different rules. Understanding these distinctions is important for patients and their families as they navigate end-of-life care.

Understanding Hospice Room and Board Costs

“Room and board” in hospice care refers to the non-medical expenses associated with daily living when care is provided in a facility or residential setting. These costs include housing, meals, utilities, and personal care assistance such as bathing and dressing. These daily living expenses are separate from the medical and supportive services provided directly by the hospice team.

Medical services covered by hospice typically include nursing care, medications related to the terminal illness, medical equipment, and support from social workers, spiritual counselors, and therapists. The distinction between these medical services and room and board is financially important. Patients and families need to recognize this difference because payment rules often vary for each component.

Medicare and Hospice Room and Board

Medicare, a primary insurer for many seniors, covers the medical and supportive services of hospice care under its Medicare Hospice Benefit. This benefit includes doctor services, nursing care, prescription medications for symptom management, and various therapies. However, Medicare generally does not cover the cost of room and board for individuals receiving hospice care in their home or in a nursing home or assisted living facility that serves as their primary residence.

There are specific, limited circumstances where Medicare does cover room and board. One such situation is General Inpatient Care (GIP), which is provided for short-term pain control or symptom management that cannot be effectively managed in other settings. This care occurs in a Medicare-approved inpatient facility, such as a hospice inpatient unit, hospital, or skilled nursing facility, until symptoms are stabilized. GIP is not intended for long-term residential care but for acute symptom management.

Another limited instance of Medicare covering room and board is for short-term Respite Care. This benefit allows a patient to stay in an approved facility for up to five consecutive days to provide a temporary break for their primary caregiver. Patients may be responsible for a small copayment, which cannot exceed the inpatient hospital deductible for the year, for this respite stay. These specific situations are temporary and do not represent routine coverage for ongoing residential costs.

Medicaid and Hospice Room and Board

Medicaid, a joint federal and state program, can provide coverage for hospice room and board, particularly for individuals who meet financial and medical eligibility criteria. For those who are dually eligible for both Medicare and Medicaid, or who qualify for Medicaid’s long-term care services, Medicaid may cover these residential costs. Medicaid programs vary by state, but many states have provisions for room and board in nursing facilities or assisted living settings.

In states, Medicaid may reimburse the hospice provider for room and board at a per diem rate, often around 95% of the skilled nursing facility rate. The hospice provider is then responsible for passing this payment through to the nursing facility. Eligibility for Medicaid coverage is based on income and asset limits, which differ from state to state. State plans or waiver programs determine the scope of room and board coverage for hospice patients residing in facilities.

Other Payment Sources for Hospice Room and Board

Beyond Medicare and Medicaid, other sources can help cover hospice room and board expenses. Private health insurance policies often include hospice benefits, but the extent of coverage for room and board can vary significantly by plan. Private plans may mirror Medicare’s limited coverage or may require out-of-pocket payments for residential costs. Individuals should contact their insurance provider to understand their policy’s benefits and any potential deductibles or copayments.

Veterans Affairs (VA) benefits offer comprehensive hospice care for eligible veterans. While the VA covers hospice services, including medical care, equipment, and supplies, the direct coverage for room and board in residential facilities can vary. Veterans receiving hospice care in a VA facility or through a VA-contracted community provider should inquire about room and board costs, as some programs may require other funding options for this component.

Long-term care insurance policies are designed to cover costs associated with extended care, including custodial care and room and board in various settings. These policies can fund hospice room and board, depending on the terms and conditions of the policy. Reviewing policy details helps understand what services and settings are covered.

For individuals without sufficient insurance or financial resources, direct out-of-pocket payments by the patient or family often cover room and board. Many hospice providers are non-profit organizations and may offer financial assistance programs or work with charitable organizations. These organizations sometimes have benevolent funds or grants to help cover non-medical costs like room and board for those in need.