Is hospice profitable? What 4,558 cost reports show
There is no single answer, so here is the distribution. Among 4,558 freestanding hospices in the FY2025 Medicare cost report file (4,162 with plausible per-day figures), the median net margin is 7.8%; a quarter report under -0.8% and a quarter over 18.3%. 27.0% report a net loss for the year. Median revenue is $202.44 per patient day against median expenses of $186.17. Nonprofits are 10.0% of the file.
Source: CMS HCRIS hospice cost report public use files (Form CMS-1984-14, public domain), FY2025 file, one latest usable report per CCN; universe = freestanding hospices with a usable Medicare cost report in the FY2025 file; fiscal years ending 2025-03-13 to 2026-06-30. Medians over hospices with plausible per-day figures (cost per day USD 40-1,000 and net margin within ±60%; the rest are counted but excluded from medians as likely reporting-unit errors). Per-day figures divide Worksheet F-2 totals by S-1 total patient days; cost shares come from Worksheet A column 7 over line 100. Data as of 2026-11-09.
Medians here (bar) vs the same national medians (mark):
By size band
| Band (total patient days) | Hospices | Revenue / day | Cost / day | Margin | At a loss |
|---|---|---|---|---|---|
| under 5,000 patient days | 879 | $206.90 | $196.58 | 3.5% | 40.0% |
| 5,000-20,000 patient days | 1,897 | $195.98 | $187.28 | 5.7% | 31.8% |
| 20,000-60,000 patient days | 1,248 | $202.40 | $176.43 | 12.0% | 17.4% |
| 60,000+ patient days | 534 | $222.44 | $188.23 | 13.2% | 13.4% |
By state
States with 10 or more hospices; each links to the state page with its size bands.
| State | Hospices | Revenue / day | Cost / day | Margin | At a loss |
|---|---|---|---|---|---|
| Alabama | 70 | $194.26 | $157.93 | 19.1% | 9.8% |
| Arizona | 181 | $187.50 | $168.24 | 10.2% | 21.5% |
| Arkansas | 32 | $216.42 | $163.45 | 18.3% | 3.4% |
| California | 1,184 | $218.06 | $207.59 | 4.2% | 32.2% |
| Colorado | 58 | $212.37 | $196.16 | 8.6% | 32.7% |
| Connecticut | 10 | $276.07 | $248.84 | 7.7% | 30.0% |
| Delaware | 10 | $212.43 | $197.45 | 5.5% | 11.1% |
| Florida | 57 | $215.12 | $201.09 | 10.1% | 20.4% |
| Georgia | 191 | $189.05 | $170.55 | 9.3% | 26.5% |
| Idaho | 40 | $181.57 | $169.81 | 8.9% | 29.7% |
| Illinois | 115 | $218.50 | $199.18 | 12.9% | 25.3% |
| Indiana | 86 | $233.48 | $222.36 | 6.3% | 29.1% |
| Iowa | 31 | $222.15 | $185.50 | 14.9% | 19.4% |
| Kansas | 54 | $202.00 | $191.66 | 6.2% | 32.6% |
| Kentucky | 15 | $252.38 | $227.50 | 7.8% | 13.3% |
| Louisiana | 111 | $200.16 | $186.61 | 9.7% | 19.0% |
| Maine | 10 | $182.66 | $137.97 | 24.2% | 0.0% |
| Maryland | 11 | $253.30 | $217.06 | 22.9% | 18.2% |
| Massachusetts | 54 | $263.16 | $246.45 | 7.1% | 18.4% |
| Michigan | 138 | $203.70 | $178.02 | 11.8% | 18.0% |
| Minnesota | 42 | $219.93 | $179.94 | 14.2% | 22.5% |
| Mississippi | 66 | $191.68 | $161.78 | 15.9% | 19.0% |
| Missouri | 93 | $210.72 | $185.91 | 6.8% | 30.9% |
| Montana | 12 | $204.90 | $168.28 | 19.9% | 8.3% |
| Nebraska | 26 | $228.84 | $202.18 | 12.7% | 25.0% |
| Nevada | 100 | $199.00 | $178.39 | 7.3% | 27.8% |
| New Jersey | 47 | $235.84 | $219.62 | 7.4% | 31.8% |
| New Mexico | 40 | $201.66 | $177.69 | 12.4% | 18.8% |
| New York | 27 | $267.73 | $260.77 | 0.9% | 37.0% |
| North Carolina | 53 | $207.87 | $207.71 | 7.5% | 27.7% |
| Ohio | 134 | $220.73 | $209.74 | 8.5% | 29.6% |
| Oklahoma | 110 | $169.68 | $151.31 | 10.9% | 26.3% |
| Oregon | 48 | $242.56 | $228.44 | 6.8% | 32.6% |
| Pennsylvania | 111 | $185.87 | $158.63 | 12.1% | 22.2% |
| Puerto Rico | 32 | $125.23 | $119.60 | 6.5% | 25.8% |
| South Carolina | 75 | $179.92 | $175.12 | 6.3% | 33.9% |
| Tennessee | 40 | $197.13 | $176.67 | 14.3% | 6.5% |
| Texas | 773 | $185.72 | $168.38 | 7.8% | 28.4% |
| Utah | 50 | $190.21 | $160.06 | 16.8% | 15.6% |
| Virginia | 72 | $181.87 | $154.88 | 13.2% | 29.2% |
| Washington | 31 | $233.32 | $222.45 | 9.1% | 34.5% |
| West Virginia | 13 | $281.09 | $260.94 | 3.8% | 18.2% |
| Wisconsin | 58 | $202.72 | $170.00 | 16.1% | 19.6% |
Reading the margin
Net margin here is net income over total revenue as filed on Worksheet F-2, which includes non-patient revenue (contributions, investment income) and non-reimbursable costs. Medicare pays a per-diem rate by level of care, so revenue per day clusters tightly around the rate while cost per day spreads much wider: the cost side is where hospices differ. The free lookup shows your own cost and revenue per day against your state and band; the USD 99 report names the 10 nearest peers with the full cost-centre split.
The paid report
USD 99, one time: your hospice vs the 10 closest named freestanding hospices (same state and patient-day band, nearest by days; census region or national pool stated when the state has fewer than 10): revenue and cost per patient day, net margin, Medicare and Medicaid day share, level-of-care mix, salary / nursing / aide / administrative / general-service shares of cost, drugs and DME per day, advertising share, each with your percentile in the full pool, and a Care Compare link per peer. Emailed within 1 business day. One free re-run within 14 days if a peer does not fit.
Get the report — USD 99 With 5-year trend — USD 149
USD 149 adds the five-year trend page: your hospice each cost-report year FY2020-2025 against that year's state median in your band, plus the Care Compare listing details. Full refund if no peer group can be formed. See the real sample.