How Much Does Hospice Cost? The Honest Numbers

For most families in Missouri, Illinois, and Kansas, hospice itself costs almost nothing out of pocket. If the person is on Medicare, the Medicare Hospice Benefit under Part A pays the hospice a daily rate that covers nursing visits, physician oversight, medications for the terminal illness, equipment, the aide, the social worker, and the chaplain, with no deductible and no coinsurance for that care. Medicare permits only two small charges: up to $5 per prescription for outpatient comfort medications, and 5% coinsurance for short inpatient respite stays. The honest part of the answer is what sits outside the benefit, and that is where real money changes hands: room and board in a nursing home or assisted living, round-the-clock private caregiving at home, and any treatment still aimed at curing the illness. Those are the costs that catch families off guard, and they are the reason this article exists.

What does Medicare's hospice benefit cover?

Hospice is not a fringe choice. The National Hospice and Palliative Care Organization, now part of the National Alliance for Care at Home, reported in its 2025 Facts and Figures that 1.91 million Medicare beneficiaries received hospice care during 2024, and that 53.1% of Medicare decedents used it, the first year a majority did. Medicare's own hospice booklet lists what the benefit pays for, and the list is longer than most people expect: physician services, nursing care, medical equipment such as a hospital bed, wheelchair, or oxygen concentrator, medical supplies like bandages and catheters, prescription drugs for pain and symptom control, hospice aide and homemaker services, physical and occupational therapy, speech-language pathology, medical social work, dietary counseling, grief and loss counseling for the patient and the family, short-term inpatient care for symptoms that cannot be managed at home, and short-term respite care. There is no deductible for any of it, and the hospice bills Medicare directly, so most families never see a bill for covered services at all.

Three details are worth knowing before you assume anything. Under the federal hospice rules at 42 CFR 418.64, a hospice must make bereavement services available to the family for up to one year after the death, and that support was already paid for by the daily rate, yet families across St. Louis, Chicago, Springfield, and Wichita routinely leave it unused because nobody told them it existed. If the person is enrolled in a Medicare Advantage plan, Original Medicare covers everything related to the terminal illness once hospice begins, so there is no need to drop the plan. And hospice runs in benefit periods, two of 90 days followed by unlimited 60-day periods with a physician recertifying each time, which means there is no automatic cutoff at six months if the person lives longer than expected.

What will you actually pay out of pocket?

Medicare.gov states the two permitted charges plainly. A hospice may charge up to $5 per prescription for outpatient drugs for pain and symptom management, and may charge 5% of the Medicare-approved amount for inpatient respite care, with total respite coinsurance capped at the inpatient hospital deductible, which CMS set at $1,736 for 2026. Many hospices waive the drug copay entirely. What does not go away are the person's ordinary Medicare Part A and Part B premiums, and their usual cost-sharing for anything unrelated to the terminal illness, such as a broken wrist or a long-standing condition that has nothing to do with the hospice diagnosis. Care arranged outside the hospice team can also be billed to you, so call the hospice before any emergency room visit or transport that is not clearly an emergency.

What does hospice not pay for?

Room and board is the big one, and it is the single most common financial surprise. Medicare is explicit that the hospice benefit does not cover room and board, whether the person lives at home, in an assisted living community, or in a nursing home. The hospice sends its team into the facility and covers the hospice care; the facility keeps billing its own daily rate exactly as before. The 2025 CareScout Cost of Care Survey, the successor to the Genworth survey and fielded from July through November 2025, put the national median at $6,200 a month for assisted living and $315 a day, or $114,975 a year, for a semi-private nursing home room. That bill continues unchanged after hospice begins, and it is paid from the resident's own funds, a long-term care insurance policy, or Medicaid.

The second gap is around-the-clock caregiving at home. Hospice aides visit; they do not move in. A typical routine home care plan might bring a nurse two or three times a week and an aide a few times a week, with a 24-hour on-call line in between, and the hours between visits fall to family or to privately hired help. The same 2025 CareScout survey puts a non-medical caregiver at a national median of $35 an hour, roughly $80,080 a year at 44 hours a week. The third gap is treatment aimed at curing the terminal illness. Electing hospice means setting that aside, and Medicare will not pay for curative chemotherapy or curative drugs for the hospice diagnosis while the benefit is elected, though a person may revoke hospice at any time and return to standard Medicare coverage if they change their mind.

The four levels of care and what Medicare pays for each

CMS pays hospices a per diem rather than per visit, and the rate depends on the level of care the patient needs that day. In the FY 2026 final rule, CMS-1835-F, CMS set the national base rates at $230.83 a day for routine home care in the first 60 days, $181.94 a day from day 61 onward, $1,674.29 a day, or $69.76 an hour, for continuous home care during a crisis at home, $532.48 a day for inpatient respite care, and $1,199.86 a day for general inpatient care. Those rates apply from October 1, 2025 through September 30, 2026 and are adjusted by a local wage index, so the actual figure in Kansas City is not the same as the one in Chicago. CMS also sets an annual cap on average per-patient payment, $35,361.44 for FY 2026, and has finalized a 2.3% increase and a $36,174.75 cap for FY 2027 beginning October 1, 2026. Read those figures as what Medicare pays the hospice, not as what a family is billed, but do not ignore them: routine home care, the level where nearly all hospice days are spent, is funded for intermittent visits rather than constant presence, which is precisely why the caregiving gap exists, and if you are paying privately these published per diems are the honest starting point for a conversation about price.

What if the person has Medicaid in Missouri, Illinois, or Kansas?

All three states cover hospice through Medicaid, mirroring the Medicare benefit's structure and levels of care, and the coverage matters most for the room and board Medicare will not touch. Under the federal rule described by Medicaid.gov, a state pays the hospice a nursing facility room and board per diem equal to 95% of its skilled nursing facility rate, less the resident's applied income, and the hospice passes that payment to the facility. Illinois follows that floor: the HFS Handbook for Hospice Agencies states the Department reimburses the hospice 95% of the facility's calculated per diem rate for basic care, minus patient income. Kansas is more generous, and a 2024 KMAP bulletin confirmed that KanCare reimburses hospice room and board at 100% of the nursing facility rate, effective July 1, 2024. In Missouri, MO HealthNet's hospice rule at 13 CSR 70-50.010 sets nursing facility payment from the state's established facility rates and makes the hospice responsible for knowing that rate and paying the facility. For someone eligible for both programs, the Medicare and Medicaid hospice periods run concurrently, which in practice is the difference between a family covering a nursing home bill and covering almost none of it.

What about veterans, private insurance, or no coverage at all?

The VA's geriatrics and extended care program states there are no copays for hospice care, whether the VA provides it directly or an organization under VA contract does, and hospice is part of the standard medical benefits package for enrolled veterans who meet the clinical need. A veteran may also use the Medicare hospice benefit instead, and a hospice social worker can help sort out which route is cleaner given where the person lives and which agencies serve that county. Private insurance and employer plans nearly always include a hospice benefit, usually modeled on Medicare's, but the plan may narrow the network, require prior authorization, or trim the bereavement follow-up. Ask for the hospice benefit language in writing before you choose an agency, not after the first visit.

If the person has no coverage at all, ask anyway. Many nonprofit hospices, and Missouri, Illinois, and Kansas all have long-established ones, provide care regardless of ability to pay, funded through donations, memorial gifts, and foundation grants, and most will not volunteer that unless you ask directly. A hospice admissions or financial counselor can also screen for Medicaid eligibility on the spot, since a terminal diagnosis and the spend-down that often precedes it change the math quickly. Free, unbiased Medicare counseling exists in each state as well: Missouri SHIP, the Illinois Department on Aging's Senior Health Insurance Program, and SHICK in Kansas. When you call a hospice, ask three plain questions: what will we be billed for, what does room and board cost where he is living now, and what happens if the money runs out. A hospice worth choosing answers all three without hedging.