Policy & oversight
GAO Finds Medicare Pays Low-Visit Hospice Agencies Twice as Much Per Visit as High-Visit Ones, and Urges Congress to Revisit the Payment Structure
A June 2026 Government Accountability Office report found that because Medicare's routine home care hospice rate is the same regardless of visit frequency, agencies delivering fewer visits effectively collect proportionally more per visit, a gap that could cost the program billions of dollars annually.
By the Goodsurance editorial teamJuly 18, 2026
The Government Accountability Office published a report in June 2026, identified as GAO-26-107585, examining how Medicare pays for routine home care under the hospice benefit, the largest payment category in the program. Medicare pays a single daily rate for each day a hospice enrollee receives care at home, regardless of how many nurse, aide, or therapist visits occur that day.
GAO's analysis of 2022 through 2024 Medicare claims found that hospices in the bottom fifth by visit intensity averaged about 2.5 visits per week per beneficiary, while those in the top fifth averaged about 5.5 visits. Because the daily rate is the same for both groups, lower-visit agencies effectively received about twice as much per individual visit as higher-visit agencies.
Medicare pays the same daily hospice rate whether an agency visits once or five times a week. A GAO report says this costs billions and recommends Congress act.
The office estimated that if Medicare had paid rates tied to actual visits for a defined set of beneficiaries in 2024, spending for that group would have been approximately 7.6 billion dollars lower. GAO recommended that Congress consider directing Medicare to revise the routine home care payment structure, potentially moving toward rates that account for visit frequency.
No legislative action had been announced as of the report's publication. CMS has not issued a formal policy response. Hospice industry groups have argued that the flat daily rate gives agencies flexibility to provide care during periods when visits are not needed. Patient-advocacy organizations have raised questions about whether low-visit agencies adequately meet the needs of people nearing the end of life.
In plain words
Medicare pays hospice agencies the same amount each day no matter how often they visit a sick person at home. A government watchdog study found that some agencies visit patients only a few times a week while others visit much more, but both get paid the same daily rate. That means agencies that visit less get paid more per visit they make. The report said this difference could cost Medicare about 7.6 billion dollars less per year if payments were based on actual visits. The government report asked Congress to consider changing how hospice agencies get paid.
Understand the basics first
Source: GAO
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