In Massachusetts, hospice care is paid for by Medicare for most patients, by MassHealth for those who qualify on income and assets, by commercial health insurance (which state law requires to include a hospice benefit), and by TRICARE or the VA for military families and veterans. Very few residents end up paying the full cost themselves. The expenses that do land on families are usually room and board in a facility and round-the-clock personal care, because no payer covers those in full.
Medicare Pays for Most Hospice Patients
Medicare Part A is the largest funder of hospice care in Massachusetts. You qualify if you’re entitled to Part A and a physician certifies you as terminally ill, meaning a prognosis of six months or less if the illness runs its expected course.1eCFR. 42 CFR 418.20 – Eligibility Requirements For the first benefit period, both the hospice medical director and your attending physician (if you have one) must sign the certification in writing.2eCFR. 42 CFR 418.22 – Certification of Terminal Illness
Electing the Medicare hospice benefit means waiving Medicare coverage for curative treatment of the terminal illness. Care for unrelated conditions continues as normal, but anything aimed at curing the terminal diagnosis has to be coordinated through the hospice team.3CMS. Medicare Benefit Policy Manual Chapter 9 That trade-off is the foundation of the hospice model.
Once you’ve elected the benefit, Medicare pays for nursing visits, home health aides, medical equipment, medications for symptom relief, counseling, social work, and short inpatient stays when symptoms can’t be managed at home. There’s no deductible. Your out-of-pocket share is capped at $5 per prescription for symptom-management drugs and 5% of the Medicare-approved amount for inpatient respite care.4Medicare.gov. Hospice Care
Coverage isn’t capped at six months. It runs in two 90-day periods followed by unlimited 60-day periods, with a hospice physician recertifying the terminal prognosis at each renewal.5CMS. Hospice Patients who stabilize can be discharged and return to standard Part A coverage, and they can re-elect hospice later if they again meet the criteria.
Three things Medicare will not cover under hospice:
- Treatment aimed at curing the terminal illness, including drugs intended to treat rather than manage symptoms.
- Room and board at home or in a nursing facility. Facility stays are only paid when the hospice team orders short-term inpatient or respite care.
- Services not arranged by the hospice team. Emergency room visits, hospital admissions, or ambulance rides tied to the terminal illness have to be coordinated through hospice, or the full bill may fall to you.
Call the hospice before accepting any outside service. That one step prevents most surprise bills.4Medicare.gov. Hospice Care
MassHealth for Lower-Income Residents
MassHealth, the state Medicaid program, covers hospice for Massachusetts residents who meet its income and asset tests. The benefit is set out in 130 CMR 437.000.6Mass.gov. 130 CMR 437.000 Hospice Services Applicants go through a financial review of monthly income and countable assets.
The reason MassHealth matters even for people who already have Medicare is room and board. Federal Medicaid law allows states to pay nursing-facility room and board for a hospice patient when the hospice and the facility have a written agreement under which the hospice manages comfort care and the facility provides housing.7Office of the Law Revision Counsel. 42 USC 1396d – Definitions Medicare won’t pay those costs. MassHealth will, under those conditions. For a dual-eligible patient in a nursing home, that difference is the whole ballgame.
Children Can Get Curative Care at the Same Time
Section 2302 of the Affordable Care Act requires state Medicaid and CHIP programs to let children receive curative, life-prolonging treatment alongside hospice care.8CMS. Hospice Care for Children in Medicaid and CHIP A child on MassHealth can continue chemotherapy or other aggressive treatment while also receiving hospice services for pain and emotional support. A physician still has to certify a prognosis of six months or less, but families don’t have to choose between fighting the illness and getting comfort care. TRICARE offers the same for beneficiaries under 21.
Private Health Insurance in Massachusetts
State law requires every commercial health insurer in Massachusetts to include a hospice benefit, with the mandate appearing in multiple chapters of the General Laws covering different insurer types, including Chapter 176A for hospital service corporations.9General Court of Massachusetts. Massachusetts General Laws Part I Title XXII Chapter 176A Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim, and the other major regional carriers include hospice in their standard medical plans. Coverage typically includes nursing, counseling, supplies, and medications, usually with pre-authorization required. Confirm your hospice provider is in-network before care begins; out-of-network use can mean sharply higher costs or outright denial.
One important gap: self-insured employer plans, where the employer pays claims directly instead of buying an insurance policy, fall under federal ERISA rules that preempt state mandates. A self-insured plan is not required to follow the Massachusetts hospice mandate, and some offer limited or no hospice benefits. If your coverage is through a large employer, ask HR whether the plan is self-insured and read the summary of benefits for the hospice terms, day limits, and cost sharing.
Veterans and Military Families
Veterans enrolled in VA healthcare receive hospice at no cost, whether the VA provides it directly or sends you to a contracted community hospice.10Department of Veterans Affairs. Hospice Care Ask your VA primary care provider for a referral. You need to be enrolled in VA healthcare, have a VA physician determine your life expectancy is six months or less, have treatment goals focused on comfort, and make an informed choice to elect hospice.11Department of Veterans Affairs. Palliative and Hospice Care
TRICARE covers hospice for active-duty family members, retirees, and other eligible beneficiaries, with no cost sharing for in-network care in 2026.12TRICARE. Health Plan Costs The benefit uses the same period structure as Medicare and requires pre-authorization and recertification. Beneficiaries under 21 are not subject to those period limits and can continue curative care alongside hospice.13TRICARE. Hospice Care
What No Payer Covers
Two costs consistently fall on families regardless of who’s paying for the hospice services themselves.
The first is room and board. If the patient lives in a nursing home or assisted living facility, neither Medicare nor most private insurers cover the daily housing cost. MassHealth does, and only under the specific agreement described above. Private rooms in skilled nursing facilities can run several hundred dollars a day, and that bill continues for the full length of the hospice stay.
The second is around-the-clock personal care. Hospice provides intermittent visits, not continuous staffing. If someone needs to be at the bedside at all times, the family either does it themselves or hires private-duty aides or nurses. Home health aide rates nationally run roughly $15 to $20 per hour, and private-duty nurses cost significantly more. Over a stay of weeks or months, this is the leading source of financial strain families report.
Charity Care from Nonprofit Hospices
Most Massachusetts hospice organizations are nonprofits that provide charity care funded by community donations. Many use sliding-scale fees based on household income so that inability to pay doesn’t block access. Ask the hospice’s social work department for a financial assessment. They can tell you whether grant-funded support is available to cover medications, aide visits, and other services that would otherwise come out of the family’s pocket.
Deducting Out-of-Pocket Hospice Costs
Hospice expenses you pay yourself that aren’t reimbursed by insurance may qualify as deductible medical expenses on your federal return. You claim them on Schedule A, and only the amount above 7.5% of your adjusted gross income counts. When a loved one is in a facility primarily for medical care, the full cost including meals and lodging can be deductible; if the stay is primarily for non-medical reasons, only the portion tied to actual medical care qualifies.14Internal Revenue Service. Medical, Nursing Home, Special Care Expenses For families paying hundreds of dollars a day in room and board or private nursing, this can be meaningful relief, but only if you itemize instead of taking the standard deduction.