Hospice Cost Report Statistics (2026): 50+ Data Points on Medicare Margins, the Aggregate Cap, and CMS-1984 Filing

The aggregate FFS Medicare margin for hospices was 8.0% in 2023 — a figure MedPAC builds directly from the Medicare cost reports hospices file every year (MedPAC, Report to the Congress: Medicare Payment Policy, March 2026). Medicare spent $28.3 billion on hospice care for more than 1.8 million beneficiaries in 2024, paid across 6,706 hospices — a provider base growing almost entirely because for-profit operators keep entering the market. Profitability hinges on one number the cost report captures better than any other: length of stay. Hospices that keep patients longest earn the highest margins, push hardest against the $35,361.44 annual per-beneficiary cap, and draw the most scrutiny. The Hospice Medicare Cost Report (Form CMS-1984-14) is where all of it reconciles, and a late filing can convert a year of payments into a recoverable overpayment. We aggregated data from MedPAC, CMS, the Medicare Administrative Contractors, and other primary sources to build the definitive statistical picture of the hospice cost report and the payment system behind it.

Key Takeaways

• The aggregate FFS Medicare margin for hospices was 8.0% in 2023, down from 9.8% in 2022 (MedPAC, March 2026).

• Medicare hospice spending reached $28.3 billion in 2024 for more than 1.8 million beneficiaries (MedPAC, March 2026).

• 6,706 hospices served Medicare beneficiaries in 2024, a 2.6% increase driven by for-profit entry (MedPAC, March 2026).

• The FY 2026 hospice aggregate cap is $35,361.44 per beneficiary (CMS, FY 2026 Final Rule).

• Cost reports (Form CMS-1984-14) are due 150 days (the last day of the fifth month) after the fiscal year-end (CMS PRM; MAC guidance).

• About 28% of hospices exceeded the cap in 2023, each by roughly $410,000 on average (MedPAC, March 2026).

• Average length of stay rose to 99.6 days in 2024; the median was just 19 days (MedPAC, March 2026).

• For-profit hospices grew about 5% in 2024 while nonprofit ownership declined (MedPAC, March 2026).

• The FY 2026 payment update is +2.6% (about +$750 million) (CMS, FY 2026 Final Rule).

• 1 in 10 hospices discharged 56% or more of their patients alive in 2023 (MedPAC, March 2026).

• Provider-based hospices ran a -25.6% margin in 2023, versus positive margins for freestanding hospices (MedPAC, March 2026).

• MedPAC recommends Congress eliminate the FY 2027 payment update (a rate freeze) (MedPAC, March 2026).

1. Filing the Hospice Cost Report (CMS-1984-14): Deadlines and Compliance

The hospice cost report is the annual reconciliation that supports Medicare settlement and feeds the national data used to set future rates. Like the home health cost report, its deadline is unforgiving.

Filing deadlines and penalties

Every Medicare-participating hospice must file an annual cost report under 42 CFR 413.20. Freestanding hospices use Form CMS-1984-14, required for cost reporting periods beginning on or after October 1, 2014 (CMS). The filing window and late-filing consequences track the standard Provider Reimbursement Manual rules.

Metric	Value	Source
Cost report form (freestanding hospice)	CMS-1984-14	CMS
Cost report due date after fiscal year-end	150 days (last day of 5th month)	CMS PRM; MAC guidance
Penalty for late/missing filing	Interim payments may be deemed overpayments	42 CFR 413.20; CMS PRM Part I §2413
Low-utilization filing threshold	$200,000 total Medicare reimbursement	CMS PRM 15-2 §110
Chain organizations	Each hospice files a separate report	42 CFR 413.20(b)
Reopening window	3 years from settlement date	CMS PRM; MAC guidance
Appeal deadline	180 days from settlement date	CMS PRM; MAC guidance

The cost report is more than a compliance formality for hospices because the program uses cost-per-day data from these filings to judge payment adequacy. Sloppy cost allocation doesn't just risk a rejected filing — it distorts the numbers regulators use to justify rate changes. A disciplined Medicare cost report filing process protects both the settlement and the integrity of an agency's reported cost per day.

2. Medicare Hospice Spending and Utilization

Hospice is one of the faster-growing parts of traditional Medicare, driven by rising election rates among decedents and longer stays.

Spending, beneficiaries, and use rates

Metric	Value	Source
Medicare hospice spending, 2024	$28.3 billion	MedPAC, March 2026
Medicare beneficiaries receiving hospice, 2024	More than 1.8 million	MedPAC, March 2026
Share of decedents electing hospice, 2023	51.7% (a new high in 2024)	MedPAC, March 2026
Average length of stay, 2024	99.6 days (up ~3 days)	MedPAC, March 2026
Median length of stay, 2024	19 days (up 1 day)	MedPAC, March 2026
Beneficiaries with length of stay over 180 days, 2024	17.5%	MedPAC, March 2026
Average routine home care visits per week, 2024	3.9	MedPAC, March 2026

The gap between the 19-day median and the 99.6-day average stay is the single most important dynamic in hospice economics: a minority of very long stays pulls the average far above the typical patient, and those long stays are where both profit and cap risk concentrate.

3. Hospice Provider Supply, Ownership, and For-Profit Growth

The number of hospices filing cost reports keeps rising, but the growth is lopsided toward for-profit entrants — a pattern regulators increasingly treat as a program-integrity signal.

Metric	Value	Source
Hospices serving Medicare beneficiaries, 2024	6,706	MedPAC, March 2026
Year-over-year provider growth, 2024	+2.6%	MedPAC, March 2026
For-profit hospice growth, 2024	~+5%	MedPAC, March 2026
Nonprofit ownership trend	Declining for several years	MedPAC, March 2026
Freestanding share of hospices, 2024	~88%	MedPAC, March 2026
Urban share of hospices, 2024	~88%	MedPAC, March 2026

For-profit entry has been the entire growth story in hospice supply for years, mirroring the concerns MedPAC has raised about aberrant provider growth in states such as California. Nonprofit and rural hospices, by contrast, are flat or shrinking.

4. What Cost Reports Reveal About Hospice Margins and Profitability

MedPAC's hospice margin analysis is built directly from Medicare hospice cost report files — which is why the accuracy of cost-per-day reporting matters well beyond a single agency's settlement.

The aggregate margin and cost per day

Metric	Value	Source
Aggregate FFS Medicare margin, 2023	8.0%	MedPAC, March 2026
Aggregate FFS Medicare margin, 2022	9.8%	MedPAC, March 2026
Projected aggregate FFS Medicare margin, 2026	~9%	MedPAC, March 2026
Average hospice cost per day, 2024	~$168	MedPAC, March 2026
Cost-per-day growth, 2024	+1.1%	MedPAC, March 2026
Cost per day, urban vs. rural, 2024	$170 vs. $156	MedPAC, March 2026

Margin variation by hospice type

Margins swing enormously by ownership, setting, and patient mix — and the cost report is what exposes the spread.

Metric (2023 aggregate FFS Medicare margin)	Value	Source
Below-cap hospices	9.0%	MedPAC, March 2026
Nonprofit hospices	2.6%	MedPAC, March 2026
Provider-based hospices	-25.6%	MedPAC, March 2026
Urban hospices	8.3%	MedPAC, March 2026
Hospices with more nursing-facility / assisted-living patients	13.3%	MedPAC, March 2026
75th-percentile hospice	~21%	MedPAC, March 2026

Profitability is tied to length of stay: hospices with longer stays have lower cost per day and therefore higher margins. That is the economic engine behind the cap disputes in the next section — and why precise cost allocation and bookkeeping determines whether a hospice's reported margin is defensible.

5. The Aggregate Cap, Long Stays, and Live Discharges

The aggregate cap limits total per-beneficiary payments and is the central compliance risk in hospice. The cost report and the cap calculation together determine whether a hospice owes money back.

Cap exceedance and long-stay concentration

Metric	Value	Source
FY 2026 aggregate cap per beneficiary	$35,361.44	CMS, FY 2026 Final Rule
FY 2025 aggregate cap	$34,465.34	CMS, FY 2026 Final Rule
FY 2027 proposed cap	$36,210.11	CMS, FY 2027 Proposed Rule
Share of hospices exceeding the cap, 2023	~28%	MedPAC, March 2026
Average cap overage per above-cap hospice, 2023	~$410,000	MedPAC, March 2026
California hospices exceeding the cap, 2023	More than half	MedPAC, March 2026

Live discharges as a quality and integrity signal

Metric	Value	Source
Hospices discharging 56%+ of patients alive, 2023	Top 10% of providers	MedPAC, March 2026
Above-cap hospice behavior	Longer stays + higher live-discharge rates	MedPAC, March 2026
MedPAC recommendation (2020, reaffirmed)	Wage-adjust and cut the cap by 20%	MedPAC, March 2026

High live-discharge rates paired with long stays are the pattern MedPAC flags as potential program-integrity abuse: it suggests admitting patients who may not meet the six-month terminal-prognosis criterion. Any hospice near the cap should treat its cost report and cap calculation as a linked, year-round exercise, not a year-end surprise.

6. Payment Rates, Levels of Care, and the FY 2026-2027 Updates

Hospice is paid a per-diem across four levels of care, updated annually. FY 2026 brought a modest raise; MedPAC wants FY 2027 frozen.

FY 2026 payment update and rates

Metric	Value	Source
FY 2026 payment update	+2.6% (~+$750 million)	CMS, FY 2026 Final Rule
Market basket / MFP components	3.3% market basket − 0.7% productivity	CMS, FY 2026 Final Rule
Non-quality-reporting penalty	Net −1.4% (4-point reduction)	CMS, FY 2026 Final Rule
Routine home care, days 1-60 (FY 2026)	$230.83 per day	CMS, FY 2026 Final Rule (Federal Register)
Routine home care, days 61+	Lower tiered per diem (~$182)	CMS, FY 2026 Final Rule
Levels of care	RHC, continuous home care, inpatient respite, general inpatient	CMS

Labor shares and the FY 2027 outlook

Metric	Value	Source
Labor share, routine home care	66%	CMS
Labor share, continuous home care	75.2%	CMS
Labor share, inpatient respite care	61%	CMS
Labor share, general inpatient care	63.5%	CMS
MedPAC FY 2027 recommendation	Eliminate the payment update (freeze)	MedPAC, March 2026

With margins projected near 9% for 2026 and payment adequacy indicators positive, MedPAC concluded current rates are sufficient and recommended no increase for 2027. For hospices, that means efficiency — and the cost report that documents it — carries more weight than the annual rate bump.

Methodology and Sources

This roundup prioritizes primary, government, and official data sources. Hospice margins, cost per day, length of stay, live-discharge rates, and cap statistics come from MedPAC's analysis of Medicare hospice cost report and claims files; payment rates, the aggregate cap, and labor shares come directly from CMS rulemaking; filing rules come from CMS regulations and the Medicare Administrative Contractors. Where a figure reflects the most recent available data (2023 margin data and 2024 utilization data published in early 2026), the year is noted inline. Margin figures for above-cap hospices exclude cap overpayments except where noted.

Sources used:

• Medicare Payment Advisory Commission (MedPAC), Report to the Congress: Medicare Payment Policy, Chapter 10: Hospice Services, March 2026

• Centers for Medicare & Medicaid Services (CMS), FY 2026 Hospice Wage Index and Payment Rate Update Final Rule, and MLN Matters MM14190

• CMS, FY 2027 Hospice Wage Index and Payment Rate Update Proposed Rule

• CMS, Hospice Facility Cost Report Form CMS-1984-14 and instructions

• CMS Provider Reimbursement Manual (PRM) Part I & 15-2, and 42 CFR 413.20

• Federal Register, FY 2026 Hospice Wage Index and Payment Rate Update (payment rate tables)

Last updated: July 2026. We update this page as new MedPAC reports, CMS rules, and hospice cost report data are released.

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Soriaga & Associates, LLC is a CPA firm with 25+ years of specialized experience in hospice, home health, and home care accounting and Medicare cost report preparation. If you have questions about your hospice's cost report, cap position, or margins, schedule a free consultation.