For families facing end-of-life decisions for a loved one, understanding Medicare coverage for hospice care is crucial.

This article explains what Medicare does and doesn't cover for in-home hospice care in 2025, helping you navigate this challenging time with clear information.

What Hospice Care Does Medicare Cover?

Medicare Part A (Hospital Insurance) covers hospice care for people who are certified by a doctor as terminally ill with a life expectancy of six months or less. When you choose hospice care, you're choosing comfort care instead of care to cure your illness.

Under Medicare's hospice benefit, coverage includes nursing services, medical equipment and supplies, medications for symptom control and pain relief, short-term respite care, social services, grief counseling, and other services determined necessary by the hospice team.

According to the Centers for Medicare & Medicaid Services, Medicare paid for hospice services for over 1.7 million beneficiaries in 2025, making it a vital resource for many families.

Does Medicare Cover 24-Hour Care?

Medicare does not typically cover 24-hour continuous care in the home as a standard hospice benefit. Instead, Medicare's hospice benefit provides intermittent care with scheduled visits from hospice team members.

However, Medicare does cover two exceptions:

1. Continuous Home Care: During crisis periods (such as severe pain or symptom management), Medicare may cover continuous nursing care for 8-24 hours, but this is temporary until the crisis resolves.
2. General Inpatient Care: If symptoms cannot be managed at home, Medicare covers short-term inpatient care at a Medicare-approved facility.

According to NHPCO (National Hospice and Palliative Care Organization), continuous home care makes up less than 5% of all hospice care provided in 2025.

What Are Your Options for 24-Hour Care?

When Medicare's hospice benefit doesn't cover the full 24-hour care your loved one needs, you'll need to explore multiple options to create a comprehensive care plan.

Feel free to talk with your Pinnie Advocate to discuss options on how to create a care plan.

Private Pay Options

Hiring private caregivers is the most direct way to supplement hospice care. Home health aides usually cost $25-35 per hour, while licensed practical nurses (LPNs) typically charge $40-65 per hour. Registered nurses (RNs) generally cost $70-120 per hour.

Many home care agencies offer package deals for 24-hour care, which may reduce the hourly rate.

Medicaid Waiver Programs

If your loved one has limited income and assets, they may qualify for additional help through Medicaid.

Home and Community-Based Services (HCBS) Waivers vary by state but can provide additional personal care services.

The Program of All-inclusive Care for the Elderly (PACE) combines medical and long-term care services for people who otherwise need nursing home care.

In 2025, approximately 20 states will have expanded their Medicaid hospice benefits to include enhanced in-home support services. Pinnie Advocates can work to understand your state’s benefit programs.

Veterans Benefits

Veterans may qualify for additional in-home support through the VA. The Aid and Attendance benefit provides monthly payments to help pay for care.

The Homemaker and Home Health Aide Program offers services to veterans who need personal care. The VA also provides up to 30 days per year of respite care for relief of family caregivers.

Long-Term Care Insurance

If your loved one has a long-term care insurance policy, review it for home care benefits and understand any elimination periods (waiting periods before benefits begin). Check if the policy has specific hospice provisions.

How to Advocate for In-Home Hospice Care Coverage

Navigating the healthcare system while caring for a terminally ill loved one can be overwhelming. Here's how to effectively advocate for the care they need.

Document Medical Necessity

Create a detailed record of your loved one's condition. Keep a daily log of symptoms, especially periods of crisis. Record all pain episodes, breathing difficulties, or other distressing symptoms.

Note how frequently nursing interventions are needed and track medication effectiveness and side effects.

These records provide concrete evidence when discussing care needs with healthcare providers and insurance representatives.

Work Closely with the Hospice Team

Your hospice team is your most important ally. Schedule a care planning meeting with the entire hospice team and ask specifically about criteria for continuous care coverage.

Request that the doctor document the need for heightened care in the medical record and follow up regularly with the hospice nurse about changing conditions.

According to Medicare guidelines, a doctor's order documenting medical necessity is essential for continuous care coverage.

Understand the Appeals Process

If continuous care is denied, request the denial in writing with the specific reason. Ask about the hospice provider's internal appeal process and file a formal Medicare appeal if necessary.

Seek Outside Advocacy

Don't hesitate to get additional help. Contact your local SHIP (State Health Insurance Assistance Program) for free Medicare counseling. Reach out to patient advocacy organizations like Pinnie. 

What to Do If Medicare Won't Cover 24-Hour Care

When continuous care isn't approved but your loved one still needs round-the-clock supervision, you'll need to create a comprehensive plan.

Create a Family Caregiving Schedule

Families providing end-of-life care spend an average of 18 hours per week on caregiving tasks.

Organizing family resources can help fill care gaps. Hold a family meeting to assess everyone's availability and create a shared online calendar for scheduling shifts.

Consider using a caregiving coordination app like Lotsa Helping Hands or CaringBridge.

Assign specific tasks to different family members based on their abilities and plan for backup coverage when scheduled caregivers need a break.

Combine Professional and Family Care

Stretching limited resources often means combining approaches. Schedule paid caregivers during the most difficult times of day and use family caregivers to fill gaps between professional visits. Consider adult day care services if your loved one is still mobile, or explore nighttime-only care options if nights are particularly challenging.

Explore Community and Non-Profit Resources

Many communities offer resources that can help. Faith-based organizations often have volunteer respite care programs, and local senior centers may offer companion services.

Non-profit organizations like Hospice Foundation of America may offer grants or assistance. Disease-specific organizations (like the ALS Association or Alzheimer's Association) often have support programs.

Consider Temporary Inpatient Options

Sometimes the best solution is temporary inpatient care. Medicare covers up to five consecutive days of inpatient respite care.

Some hospice organizations have dedicated inpatient facilities, many nursing homes offer short-term stays, and some hospitals have palliative care units for symptom management.

A temporary inpatient stay can provide family caregivers with rest while ensuring your loved one receives proper care during particularly difficult periods.

Financial Planning for Extended Care

If long-term 24-hour care becomes necessary, consult with an elder law attorney about legal options for protecting assets.

Investigate accelerated death benefits if your loved one has life insurance. Consider a home equity line of credit if home ownership is a factor, and research local foundations that provide emergency financial assistance.

The Bottom Line

While Medicare's hospice benefit provides valuable end-of-life care, it has limitations when it comes to 24-hour continuous care. Understanding these limitations ahead of time helps families plan appropriately.

Medicare focuses on providing intermittent skilled care while supporting family caregivers.

For patients who need constant supervision or care, families often need to piece together multiple resources or consider temporary inpatient care during crisis periods.

By understanding what Medicare does and doesn't cover, you can better advocate for your loved one and plan for additional care needs during this difficult time.