The Medicare Hospice Benefit Explained

Who qualifies for Medicare hospice, how benefit periods work, what is covered, the four levels of care, costs, and how to stop or switch.

Who is eligible

The Medicare hospice benefit is part of Medicare Part A. According to Medicare.gov, a person can get hospice care when they have Part A and meet all three of these conditions:

• Their doctors certify that they are terminally ill, with a life expectancy of 6 months or less if the illness runs its normal course.
• They accept comfort care (palliative care) instead of care to cure the illness.
• They sign a statement choosing hospice instead of other Medicare-covered treatment for the terminal illness and related conditions.

For the first benefit period, the certification comes from the hospice medical director or a hospice physician and the patient's attending doctor, if they have one. For later periods, a hospice physician recertifies (42 CFR 418.22). Hospice is not only for people with cancer; it is for anyone whose doctors expect the illness to be terminal within that timeframe (Medicare Hospice Benefits booklet).

Benefit periods: 90, 90, then 60 days

Hospice care is given in benefit periods: two 90-day periods, followed by an unlimited number of 60-day periods (42 CFR 418.21). People sometimes worry that hospice "runs out" after six months. It does not. A patient who lives longer than expected can keep receiving hospice as long as a hospice doctor recertifies at the start of each new period that they remain terminally ill. Before the third benefit period and each one after it, a hospice physician or nurse practitioner must have a face-to-face encounter with the patient to support the recertification (42 CFR 418.22). The patient does not need to re-choose hospice for each period.

What is covered

Once hospice begins, Original Medicare covers what is needed for the terminal illness and related conditions, as long as it comes through the Medicare-approved hospice. Depending on the plan of care, this can include (Medicare Hospice Benefits booklet):

• Doctor services and nursing care
• Medical equipment such as wheelchairs or walkers, and supplies such as bandages and catheters
• Prescription drugs for pain and symptom control
• Hospice aide and homemaker services
• Physical and occupational therapy and speech-language pathology
• Social work, dietary counseling, and grief and loss counseling for the patient and family
• Short-term inpatient care for pain and symptom management, and short-term respite care

A hospice nurse and doctor are on call 24 hours a day, 7 days a week. Medicare also covers a one-time consultation with a hospice medical director or hospice doctor before you decide.

The four levels of care

Medicare pays hospices under four levels of care, defined in 42 CFR 418.302:

1. Routine home care. The patient is at home and is not receiving continuous care. The hospice team visits according to the plan of care.
2. Continuous home care. During a brief period of crisis, the patient receives care that is predominantly nursing care on a continuous basis at home, to manage acute symptoms and help the patient remain at home (42 CFR 418.204).
3. General inpatient care. Short-term care in an inpatient setting for pain control or symptom management that cannot be handled in other settings. It must be provided in a Medicare-certified hospice inpatient unit, hospital, or skilled nursing facility that meets hospice standards (42 CFR 418.108).
4. Inpatient respite care. A short inpatient stay that gives family caregivers a rest. Respite can be used only occasionally and for no more than five consecutive days at a time.

What you pay

There is no deductible for hospice. Per Medicare.gov and the Medicare Hospice Benefits booklet, patients may pay:

• A copayment of up to $5 per prescription for outpatient drugs for pain and symptom management.
• 5% of the Medicare-approved amount for inpatient respite care.
• Their usual Part A and Part B premiums.

A Medigap policy covers hospice costs for drugs and respite care. Care for health problems unrelated to the terminal illness is still covered by Original Medicare, with the normal deductibles and coinsurance.

What is not covered

Once the hospice benefit starts, Medicare will not cover (Medicare Hospice Benefits booklet):

• Treatment intended to cure the terminal illness or related conditions.
• Prescription drugs to cure the illness (drugs for unrelated conditions may be covered by Part D).
• Care from a provider not set up by the hospice team, other than the attending doctor the patient chose.
• Room and board. Medicare covers a facility stay only when the hospice team arranges short-term inpatient or respite care.
• Emergency room care, inpatient hospital care, or ambulance transport related to the terminal illness unless the hospice arranges it. Call the hospice first, or you may owe the full cost.

Stopping hospice, switching, and appeals

A patient or representative can revoke the hospice election at any time by signing a statement with the effective date, which cannot be earlier than the date it is signed (42 CFR 418.28). Regular Medicare coverage resumes, and the patient can elect hospice again later if still eligible. Revoking is different from changing hospices, which is allowed once per benefit period without losing coverage (42 CFR 418.30).

If the hospice decides the patient no longer qualifies and the family disagrees, the patient can ask the BFCC-QIO for a fast review. Medicare says you should get a Notice of Medicare Non-Coverage at least two days before covered services end, and should request the appeal by noon the day before the end date listed on it (Medicare fast appeals).

This guide is general information, not medical or legal advice. Amounts and rules can change each year; confirm with Medicare at 1-800-MEDICARE.

Updated 2026-09-30.