Navigating Hospice Costs in CT: 2026 Medicare & Insurance Guide
- Fairfield County House
- Jan 15
- 3 min read
When a loved one is facing a terminal illness, the last thing a family should worry about is a balance sheet. However, "How much does this cost?" is often the first question on a caregiver's mind.
In 2026, hospice care remains one of the most comprehensive benefits under Medicare, yet residential hospice—the "Hospice House" model—carries specific financial nuances that families must understand to avoid surprises.
The 2026 Medicare Hospice Benefit: What’s Covered?
For the vast majority of Americans over 65, the Medicare Hospice Benefit (Part A) covers nearly 100% of clinical costs related to a terminal diagnosis. For Fiscal Year 2026, CMS has increased hospice payment rates by 2.6%, ensuring that providers can maintain high standards of care despite rising inflation.
Under Medicare Part A, you typically pay $0 for:
Nursing & Physician Services: Regular visits from hospice-certified clinicians.
Medical Equipment: Hospital beds, oxygen, and mobility aids delivered to the home or facility.
Medical Supplies: Incontinence products, bandages, and hygiene supplies.
Medications: Drugs for pain and symptom management (though a small copay of up to $5 per prescription may apply).
Therapies: Physical, occupational, and speech therapy as needed for comfort.
Counseling: Spiritual and dietary support for the patient, plus bereavement support for the family for up to 13 months.
The "Room and Board" Gap
The most critical distinction in hospice care is the difference between clinical care and room and board.
The Rule: Medicare and most private insurance plans cover 100% of the medical care provided by a hospice agency. However, they generally do not cover the room and board costs if a patient lives in a residential hospice house or a nursing home.
This is where Fairfield County House provides a vital bridge. While the clinical hospice agency you choose (like RVNAhealth or Waveny) bills Medicare for the nursing and doctor visits, Fairfield County House provides the 24/7 residential environment, meals, and specialized caregiver support that "Home Hospice" cannot.
Private Insurance & Connecticut Law
Connecticut is a leader in healthcare protections. Under CT General Statute § 38a-492v, most individual and group health insurance policies in the state are required to provide coverage for hospice services.
If you are under 65 and using private insurance (Cigna, Aetna, Anthem, etc.), your "out-of-pocket" will depend on your specific plan’s deductible and co-insurance. Our team at Fairfield County House frequently works with families to help verify benefits and clarify what their specific policy covers regarding residential stays.
Medicaid and the "Covered CT" Program
For those with limited income, Medicaid (HUSKY) often provides more robust coverage for residential care. In 2026, the Covered CT Program continues to expand, offering $0 premium and $0 cost-sharing plans for eligible residents who fall just above the Medicaid income limit.
Summary Table: Estimated Costs 2026
Service Type | Medicare/Medicaid Coverage | Private Insurance |
Clinical Care (Nursing, MD) | 100% Covered | Usually Covered (Subject to Plan) |
Medications (Symptom-related) | $0 - $5 Copay | Varies by Plan |
Medical Equipment | 100% Covered | Usually Covered |
Residential Room & Board | Not Covered (Except GIP/Respite) | Rarely Covered |
Bereavement Support | 100% Covered | Usually Covered |
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Why a Nonprofit Hospice House Matters
As a 501(c)(3) nonprofit, Fairfield County House is committed to providing care regardless of a family's financial situation whenever possible. Because we are not a corporate-owned facility, our resident care is supported by community donations and grants, which helps us keep our residential fees as accessible as possible.
Take the Next Step: Financial anxiety shouldn't stand in the way of a dignified end-of-life journey.
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