Medicare Part A pays for most hospice care in Florida, covering nursing visits, medications, medical equipment, counseling, and physician services at little or no cost to the patient. Florida Medicaid, the VA, TRICARE, and private insurance cover hospice for people who qualify through those programs. For families using Medicare, out-of-pocket costs are usually limited to a drug copayment of up to $5 per prescription and, if the patient lives in a nursing facility, the daily room and board charge that Medicare will not pay.
Medicare Part A: The Main Payer
Medicare Part A is the primary source of hospice funding for most Florida seniors. Once you elect hospice, Medicare covers nursing care, physical and occupational therapy, medical social services, home health aide visits, physician services, medical supplies, durable equipment such as hospital beds and oxygen concentrators, counseling for the patient and family, and medications for pain and symptom control.1Office of the Law Revision Counsel. 42 USC 1395x – Definitions
Coverage runs in benefit periods: two 90-day periods followed by an unlimited number of 60-day periods. There is no overall cap on how long you can stay in hospice, as long as a physician continues to confirm at the start of each new period that your life expectancy remains six months or less if the illness runs its expected course.2Office of the Law Revision Counsel. 42 USC 1395d – Scope of Benefits3Social Security Administration. POMS HI 00601.295 – Hospice Care – Requirements for Coverage
What Medicare Pays For: The Four Levels of Care
Medicare pays for four levels of hospice care, and the hospice team assigns the level that matches your clinical situation. Only one level is paid per day.4eCFR. 42 CFR 418.302 – Payment Procedures for Hospice Care
- Routine home care, the most common level, covers scheduled visits from nurses, aides, social workers, and chaplains while symptoms are controlled at home.
- Continuous home care provides at least eight hours of predominantly nursing care in a 24-hour period during a medical crisis, so the patient can stay home rather than move to a facility.
- Inpatient respite care is short-term care in a hospital, nursing facility, or hospice inpatient unit to give the primary caregiver a break, limited to five consecutive days at a time.
- General inpatient care covers short-term stays in an inpatient facility when pain or symptoms cannot be managed at home, and ends once the crisis is resolved.5Medicare.gov. Medicare-Certified 4 Levels of Hospice Care
What You Pay Out of Pocket on Medicare
Medicare hospice has no deductible, and the hospice program bills Medicare directly. Two charges can reach the patient:
- A prescription drug copayment of up to $5 per prescription for medications that manage pain and symptoms. Each hospice sets the exact copay on a sliding scale that approximates 5 percent of the drug’s cost, but it can never exceed $5.6Social Security Administration. Social Security Act Section 1813
- Coinsurance of 5 percent of the Medicare-approved amount for each day of inpatient respite care.7Centers for Medicare & Medicaid Services. Hospice
The Big Gap: Room and Board
The main thing Medicare hospice does not pay is residential room and board. If the patient lives in a nursing home or assisted living facility, Medicare covers the hospice medical services but not the daily charge to live there.7Centers for Medicare & Medicaid Services. Hospice Nursing facility rates in Florida can run from several hundred to over a thousand dollars per day depending on the facility and region, and families typically cover that cost through Medicaid, long-term care insurance, or private funds.
Electing hospice also means waiving Medicare coverage for treatments aimed at curing the terminal illness. Medicare still pays for care unrelated to that diagnosis — a broken bone or a separate chronic condition is covered under standard Medicare benefits — and the attending physician’s services remain covered during hospice.2Office of the Law Revision Counsel. 42 USC 1395d – Scope of Benefits
Florida Medicaid: Closing the Room-and-Board Gap
Florida Medicaid covers hospice for residents who meet income and asset limits. The benefit runs through the Statewide Medicaid Managed Care program and is governed by the Florida Medicaid Hospice Services Coverage Policy.8Legal Information Institute. Florida Admin Code R. 59G-4.140 – Hospice Services Covered services mirror Medicare’s: nursing, medications, equipment, and counseling.
The practical advantage is that Florida Medicaid pays nursing facility room and board for hospice patients, which Medicare does not.9Florida Agency for Health Care Administration. Florida Medicaid Hospice Services Coverage Policy For patients who qualify for both programs — “dual eligible” — Medicare pays for the hospice services and Medicaid pays the facility room and board. For many Florida families, this combination eliminates nearly all out-of-pocket end-of-life costs. The Florida Agency for Health Care Administration oversees Medicaid hospice reimbursement, with rates set by the state and updated to reflect regional costs.
VA, TRICARE, and Private Insurance
Veterans enrolled in VA healthcare receive hospice as part of the VA medical benefits package, which includes hospice, palliative care, and respite care. Veterans can get these services at VA facilities or through community providers contracted by the VA.10eCFR. 38 CFR Part 17 – Medical
Active-duty service members and their dependents are covered through TRICARE, which includes hospice and inpatient respite care capped at five consecutive days at a time. TRICARE deductibles and cost-sharing depend on the sponsor’s pay grade and plan type.11eCFR. 32 CFR 199.4 – Basic Program Benefits
Most private health plans — through an employer or the marketplace — cover hospice, but copayment structures, deductibles, and pre-authorization rules vary. Check your summary of benefits for what you may owe on medications and inpatient care.
If You Have No Insurance
Florida hospice organizations commonly run charitable care programs funded by donations and grants. They use sliding-scale fees or fully uncompensated care so residents without coverage are not turned away. Providers typically assess your financial situation during the initial consultation and apply available charitable resources to nursing, medications, and equipment. If you or a family member has no insurance, raise the question with the hospice admissions team at the first meeting.
Deducting What You Do Pay
Out-of-pocket hospice-related costs — including nursing facility room and board when Medicare does not cover it — can qualify as medical expenses on your federal tax return. You can deduct the portion of qualifying medical expenses that exceeds 7.5 percent of your adjusted gross income, and the cost of staying in a nursing home or similar facility counts when the primary reason for being there is medical care, including meals and lodging.12Internal Revenue Service. Publication 502 – Medical and Dental Expenses Reduce your deductible expenses by any insurance reimbursement received during the year, and itemize on Schedule A of Form 1040 to claim it.