When a doctor says it's time for hospice, Medicare's benefit sorts your parent's care into four levels, and you pay $0 for all of them. Those levels are routine home care for everyday needs, continuous home care during a crisis, general inpatient care for symptoms that can't be controlled at home, and inpatient respite care to give you a breather. Here's what each one means, when the hospice team uses it, and the two small costs to watch for.

In This Guide

The Four Levels of Medicare Hospice Care

Hospice isn't one flat service. Medicare pays for it as four distinct levels, and the hospice team moves your parent between them as their symptoms and needs change. The levels are set out in federal regulation: the Medicare hospice Conditions of Participation at 42 CFR Part 418, with the four payment levels defined at 42 CFR 418.302. Every Medicare-certified hospice uses the same four.

Two of them happen where your parent lives. Two happen in a facility. Most of hospice, day to day, is the first level on this list.

Level Where it happens When it's used
Routine home care Wherever the person lives (home, assisted living, nursing home) The everyday, most common level, when symptoms are managed and stable
Continuous home care The person's home A short crisis, when intense mostly-nursing care is needed to stay home
General inpatient care A hospice unit, hospital, or nursing facility Short-term, when pain or symptoms can't be controlled at home
Inpatient respite care A Medicare-approved inpatient facility A short stay to give the family caregiver a break

How Each Level of Medicare Hospice Care Works

Routine home care is the level most families spend nearly all of hospice in. It's the everyday care delivered wherever your parent calls home, whether that's their own house, an assisted living community, or a nursing home. The hospice team, the nurse, aide, chaplain, and social worker, comes to them on a schedule, and you and any other family are the day-to-day hands in between visits. This is the baseline level when symptoms are under control.

Continuous home care is what the hospice reaches for when a crisis hits and the goal is to keep your parent out of the hospital. It's furnished only during a brief period of crisis, and it's mostly nursing care, brought into the home for hours at a stretch to get a bad stretch of pain, agitation, or breathing trouble back under control. Think of it as the home version of intensive care: short, focused, and meant to end once the crisis passes.

General inpatient care is for when symptoms simply can't be managed where your parent lives. It's short-term care in an inpatient setting, a hospice unit, a hospital, or a nursing facility with a hospice contract, aimed at pain control or acute symptom management that isn't working at home. It's not a permanent move; the plan is to get the symptoms settled and, when possible, bring your parent back to routine home care.

Inpatient respite care is the one level that exists for you, not the patient. Caregiving is exhausting, and Medicare builds in a short inpatient stay so the family caregiver can rest, handle an emergency, or just sleep for a few nights. Your parent goes to a Medicare-approved facility for a few days and the hospice keeps managing their care there. The rule to know: Medicare won't reimburse more than five consecutive days of respite at a time. You can use respite more than once, but each stretch caps at five days, so it's a pressure valve, not a long-term placement.

What Medicare Hospice Care Costs You

Good news on this one. When you get hospice from a Medicare-approved provider, you pay $0 for the hospice care itself, across all four levels. That's the whole point of the benefit: end-of-life care shouldn't come with a running meter, and according to Medicare's hospice coverage page, it doesn't.

There are two small exceptions, and they're worth knowing so a bill doesn't surprise you. As of 2026, you may owe a copayment of up to $5 for each outpatient prescription drug for pain and symptom management, and for inpatient respite care you may pay 5% of the Medicare-approved amount. Both are modest, and everything else about the four levels, the nurse visits, the crisis nursing, the inpatient symptom management, carries no cost-sharing.

Frequently Asked Questions

What are the four levels of Medicare hospice care?

Routine home care, continuous home care, general inpatient care, and inpatient respite care. Nearly all hospice happens at the routine home care level; the other three are short-term steps up for a crisis, facility-based symptom control, or a caregiver break.

How many days of respite care will Medicare hospice cover?

Medicare won't reimburse more than five consecutive days of inpatient respite at a time. You can use respite more than once during hospice, but each individual stay caps at five days, so it's meant as an occasional break for the caregiver, not an ongoing arrangement.

What's the difference between continuous home care and general inpatient care?

Both are for a crisis, but the location and the goal differ. Continuous home care brings intense, mostly-nursing care into your parent's home to keep them there through an acute episode. General inpatient care moves them to a hospice unit, hospital, or nursing facility when the pain or symptoms can't be controlled at home.

Does Medicare hospice cost anything?

For the hospice care itself, no. You pay $0 to a Medicare-approved provider at every level. Two small copays are the only exceptions: up to $5 for each outpatient pain or symptom prescription, and 5% of the approved amount for an inpatient respite stay.

Can my parent get hospice at home, or does it mean a facility?

Most hospice is delivered right where your parent lives, which is the routine home care level, and "home" includes a private residence, assisted living, or a nursing home. The inpatient levels are used only when a crisis or the caregiver's need for a break calls for a short facility stay.

Learn More

MedicareMedicare Hospice Benefit: Coverage, Costs, and When to Call HospiceThe Medicare hospice benefit covers end-of-life care at almost no cost, but not room and board. What it pays, what it doesn't, who qualifies, and when to call. MedicareWho Qualifies for Medicare Hospice CareWho qualifies for Medicare hospice? Part A covers it once two doctors certify a terminal illness of six months or less and you choose comfort care. MedicarePalliative Care vs. Hospice: The Real Difference (and How to Choose)Palliative care and hospice aren't the same. Here's the real difference in plain terms, the Medicare cost gap, and how to know which your parent needs.

Find personalized help understanding which level of Medicare hospice care fits your parent at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.