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Walter Koenig, who played Ensign Pavel Chekov on the original “Star Trek,” has died at 90 (1).
One report says he died at his home in Los Angeles (2). Another, citing a post from Galactic Productions, says he died of old age at a home in North Hollywood, with his daughter and niece at his side (1).
Plenty of us would sign up for that ending: at home, at 90, with family close by. What fewer families know is how Medicare handles it, and where the bills land.
Let’s discuss.
I’ve been a CPA since 1981, and in my view this is one of the most misunderstood corners of Medicare.
The good news first: if a doctor certifies a life expectancy of six months or less, Medicare’s hospice benefit pays for comfort care, usually at home, and you pay nothing for the hospice care itself (3).
Families use it, but in my view, often too late. In 2024, 52.9% of Medicare beneficiaries who died had received hospice care, and the median stay was just 19 days (4).
The bad news: Medicare doesn’t pay for 24-hour care at home (5). And a non-medical caregiver for 44 hours a week now costs a national median of $80,080 a year, according to CareScout’s 2025 survey (6).
Here’s what Medicare will and won’t cover when someone you love wants to stay home.
1. Round-the-clock help at home isn’t covered
This one catches a lot of families off guard. Medicare doesn’t pay for 24-hour-a-day care at home, meal delivery, or personal care like help with bathing and dressing when that’s the only care someone needs (5).
Hospice doesn’t change that. Medicare won’t pay for room and board at home (3), and the daily hands-on help has to come from somewhere: a spouse, a grown child or paid caregivers.
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2. Hospice itself costs almost nothing
Once you’re in hospice through a Medicare-approved provider, you pay nothing for hospice care (3). Drugs for pain and symptom control carry a copay of up to $5 per prescription (3).
There’s even help for the caregiver. Inpatient respite care, a short stay that gives family a break, may cost you 5% of the Medicare-approved amount (3).
The trade-off: you choose comfort care instead of treatment meant to cure the terminal illness (3).
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3. A care facility means paying room and board
“Home” can mean a nursing home or assisted living, and hospice can be provided there too (3). But Medicare still won’t pay the room-and-board bill (3).
That bill is big. A private nursing home room runs a median $129,575 a year, and assisted living runs a median $74,400 a year (6).
If you’re trying to figure out how to pay for years of care, a real plan beats guesswork.
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4. Don’t wait for the last few weeks
That median stay of 19 days tells you something (4). In my view, many families start hospice late, when there’s little time left to use the help it offers.
You don’t need to wait for a crisis to ask about it. The benefit requires a doctor’s certification of a life expectancy of six months or less, not six days (3).
My honest take
None of us can count on choosing our ending. But we can choose whether our families have to guess.
Talk with your doctor and your family about what you want before you need to. Know what Medicare covers, know what it doesn’t, and know who will pay the difference.
Walter Koenig’s family reportedly got to be there at the end. Planning ahead is how you give your own family that same chance.
Sources: 1. Gray News via azfamily; 2. WJLA; 3. Medicare.gov (hospice); 4. MedPAC; 5. Medicare.gov (home health); 6. CareScout via Business Wire
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