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Medicare Hospice Coverage: What Beneficiaries Must Know

Senior hands holding Medicare card near window

Medicare covers hospice care under Part A for eligible beneficiaries who elect the benefit. Once you elect hospice, Medicare pays the hospice provider directly for a defined set of palliative services, and your out-of-pocket costs are minimal. Three things to know immediately: hospice focuses on comfort rather than curing the terminal illness, you must meet specific certification requirements to qualify, and Medicare-approved hospices must provide a broad team of services under a single coordinated plan of care.

Before reading further, here are your most important immediate actions:

  • Confirm you have Medicare Part A (check your Medicare card or log in to Medicare)
  • Ask your attending physician whether a six-month prognosis certification is appropriate
  • Contact a Medicare-approved hospice in your area to request an intake consultation

More than 1.7 million Medicare beneficiaries used hospice in 2023, according to MedPAC, making it one of the most widely used end-of-life benefits in the program. If you or a family member may be approaching eligibility, understanding the rules now prevents costly delays later.

Key Takeaways

Medicare’s hospice benefit under Part A covers a broad set of palliative services for eligible beneficiaries with a six-month prognosis, with minimal out-of-pocket costs and unlimited benefit periods for those who continue to qualify.

Point Details
Medicare Part A covers hospice Eligible beneficiaries pay no hospice deductible; Medicare pays the provider directly for covered palliative services.
Four levels of care exist Routine home care, continuous home care, general inpatient care, and inpatient respite care each serve a different level of need.
Benefit periods are unlimited Two initial 90-day periods are followed by unlimited 60-day periods; face-to-face recertification is required from the third period onward.
Out-of-pocket costs are limited Beneficiaries owe up to $5 per drug prescription and 5% coinsurance for respite care; room and board in a nursing facility is not covered.
Mountaintop Insurance offers free guidance Central Oregon residents can schedule a no-cost consultation to clarify Part A, Medigap, and Part D interactions before electing hospice.

Table of Contents

What does Medicare’s hospice benefit actually cover?

Hospice under Medicare is not a place — it is a philosophy of care, and a payment structure built around it. The Centers for Medicare and Medicaid Services (CMS) defines hospice as comfort-focused, palliative care for people with a terminal illness, provided instead of curative treatment for that condition. CMS administers the benefit through Medicare Part A, and the hospice provider, not the beneficiary, receives the Medicare payment for covered services.

The hospice team is interdisciplinary by design. A Medicare-approved hospice must provide, at minimum:

  • A hospice physician or medical director
  • Registered nurses and licensed practical nurses
  • Hospice aides and homemaker services
  • Social workers
  • Counselors, including bereavement counselors
  • Chaplains or spiritual care providers
  • Trained volunteers

All of these professionals work from a single individualized plan of care, updated as the patient’s condition changes. Medicare covers hospice in several settings: the patient’s home, a nursing facility, a Medicare-certified hospice inpatient unit, or a hospital when inpatient care is arranged by the hospice. The setting does not change the benefit structure — the hospice remains responsible for coordinating all covered services regardless of where care is delivered.

The four levels of hospice care Medicare pays for

Medicare’s hospice benefit covers a broad set of services organized into four distinct levels of care. Each level corresponds to a different intensity of need, a different care setting, and a different payment structure. Understanding which level applies to a given situation determines what Medicare pays and what the patient experiences day to day.

Covered services across all levels include:

  • Physician and nursing services
  • Prescription drugs for symptom control and pain relief
  • Durable medical equipment (DME) and supplies for palliation
  • Hospice aide and homemaker services
  • Physical, occupational, and speech therapy for symptom management
  • Medical social services
  • Dietary counseling
  • Short-term inpatient care for pain and symptom management
  • Inpatient respite care
  • Bereavement counseling for the patient and family
  • Any other item or service included in the written plan of care, per 42 CFR § 418.202
Level of Care When It’s Used Typical Setting Payment Structure
Routine Home Care (RHC) Day-to-day palliative care when the patient is not in crisis Patient’s home or nursing facility Daily rate (two-tier: higher for days 1–60, lower thereafter)
Continuous Home Care (CHC) Short-term crisis: pain or symptom management requiring primarily nursing care for extended hours Patient’s home Hourly rate; RN must provide at least half the hours
General Inpatient Care (GIP) Pain or symptom management that cannot be managed at home Hospice inpatient unit, hospital, or SNF with RN on-site continuously Daily rate, higher than RHC
Inpatient Respite Care (IRC) Short-term relief for the primary caregiver, up to 5 consecutive days Medicare-approved facility Daily rate; beneficiary pays 5% coinsurance

A note on Medicare Advantage: When a beneficiary enrolled in a Medicare Advantage (MA) plan elects hospice, the hospice benefit reverts to Original Medicare (Part A). The MA plan is no longer responsible for hospice services, though it continues to cover services unrelated to the terminal diagnosis. The MA plan must help the enrollee locate a Medicare-approved hospice when requested.

Who qualifies and how to elect hospice coverage

Eligibility for the Medicare hospice benefit rests on four requirements, all of which must be met simultaneously:

  1. Medicare Part A entitlement — the beneficiary must be enrolled in Part A
  2. Physician certification — a physician must certify that the beneficiary’s life expectancy is six months or less if the illness runs its normal course
  3. Acceptance of palliative care — the beneficiary must agree to receive comfort-focused care and waive Medicare payment for curative treatment of the terminal illness
  4. Signed hospice election statement — the beneficiary (or authorized representative) signs a formal election statement designating a specific Medicare-approved hospice

The attending physician and the hospice medical director both sign the initial certification. SSA program guidance clarifies that the attending physician’s signature on the initial certification is particularly important: if a beneficiary has an established attending physician, their cooperation on the first certification supports a smoother enrollment and reduces the risk of initial payment disputes.

Benefit periods and recertification

Under 42 CFR Part 418, the benefit periods are structured as follows:

Period Duration Recertification Required?
First benefit period 90 days No (initial certification only)
Second benefit period 90 days Yes — physician recertification
Third and subsequent periods 60 days each (unlimited) Yes — face-to-face visit required

Timeline of Medicare hospice benefit periods and recertification

Starting with the third benefit period, a hospice physician or nurse practitioner must conduct a face-to-face visit with the patient before recertification. This visit confirms the patient still meets the six-month prognosis standard.

How to elect hospice — step by step:

  1. Discuss the hospice option with your attending physician and request a certification if appropriate
  2. Choose a Medicare-approved hospice (see the next section for how to verify approval)
  3. Sign the hospice election statement, which designates the hospice and confirms your agreement to palliative-focused care
  4. The hospice files a Notice of Election (NOE) with Medicare — late filing can create billing gaps, so confirm the hospice submits it promptly
  5. Keep a copy of the election statement and any addendum listing services the hospice will not provide; CMS’s model election statement shows exactly what these documents must contain

How to find and evaluate a Medicare-approved hospice

Not every hospice is Medicare-certified, and choosing one that is not means Medicare will not pay for services. Verification is straightforward: Medicare.gov’s Care Compare tool lets you search hospices by ZIP code and confirms Medicare certification status. Your State Health Insurance Assistance Program (SHIP) can also help, and the Medicare Getting Started booklet lists 1-800-MEDICARE as a direct resource.

Beyond certification, here is what to evaluate when choosing among Medicare-approved hospices:

  • Staff mix and availability: Does the hospice employ its own RNs around the clock, or does it rely heavily on on-call contractors?
  • CHC and GIP capability: Can the hospice provide continuous home care directly, or must it contract it out? Contracted CHC can mean delays during a crisis.
  • Inpatient bed access: Does the hospice have contracted beds at a local hospital or inpatient unit, and how quickly can it arrange a transfer?
  • Communication practices: How does the hospice communicate with family caregivers — daily check-ins, a dedicated nurse line, or only scheduled visits?
  • Grievance and appeal support: Does the hospice have a clear process for handling coverage disputes and helping beneficiaries file appeals?
  • Bereavement services: How long does the hospice provide bereavement support to the family after the patient’s death? Medicare requires at least 13 months.

Pro Tip: During the intake call, ask specifically: “Do you provide continuous home care in-house, or do you contract it out?” and “How quickly can you arrange general inpatient care if symptoms become unmanageable at home?” A hospice that hesitates or gives vague answers on these two questions may struggle to deliver the higher levels of care when they matter most.

Reviewing questions to ask when comparing plans can also help you structure that intake conversation.

What hospice costs you — and how Medigap and Part D fit in

The financial structure of Medicare hospice coverage is one of its most misunderstood aspects. Most beneficiaries pay very little directly for hospice services, but the rules have specific limits worth knowing.

What you owe under Original Medicare:

  • No hospice deductible — Medicare pays the hospice provider directly with no upfront deductible for covered services
  • Prescription drug copay — up to $5 per prescription for drugs related to symptom control and pain relief, per the Medicare hospice benefits booklet
  • Inpatient respite coinsurance — 5% of the Medicare-approved amount for each respite day (capped at the Part A inpatient deductible for a spell of illness)
  • Room and board in a nursing facility — Medicare does not cover room and board when a hospice patient lives in a nursing facility; the patient or Medicaid pays that cost
  • Services unrelated to the terminal illness — standard Medicare deductibles and coinsurance apply for any care unrelated to the terminal diagnosis

MedPAC reports that more than 1.7 million Medicare beneficiaries used hospice in 2023, reflecting how central this benefit has become to end-of-life care in the United States.

How Medigap interacts with hospice

Prescription pill bottles and pill organizer on table

A Medigap (Medicare Supplement) policy can cover the 5% respite coinsurance and other cost-sharing for services unrelated to the terminal illness that remain under Original Medicare. Medigap does not pay for room and board in a nursing facility, and it does not cover services the hospice itself is responsible for providing. If you are considering Medigap alongside a potential hospice election, understanding how the two interact is worth a dedicated conversation with a Medicare advisor.

Medicare Part D and hospice

After hospice election, the hospice is responsible for covering drugs related to the terminal illness. However, Part D may still cover drugs for conditions unrelated to the terminal diagnosis. Beneficiaries should not automatically cancel their Part D plan upon electing hospice.

Medicare Advantage enrollees revert to Original Medicare for hospice services, as noted above. Their MA plan continues to cover unrelated conditions, and they should confirm with their MA plan what cost-sharing applies to those non-hospice services.

Common Medicare mistakes that can cost you money include dropping Part D at hospice election or assuming Medigap covers nursing facility room and board — both errors can create unexpected bills.

How to revoke hospice, switch providers, and appeal denials

Hospice election is not permanent. Beneficiaries can revoke, change providers, or appeal coverage decisions, and each path has specific steps and timelines.

Revoking hospice election

  1. Submit a signed written revocation statement to the hospice
  2. The hospice notifies Medicare; coverage for hospice services ends on the revocation date
  3. The remainder of that benefit period is forfeited — you cannot return to the same period
  4. After revocation, you regain full Medicare coverage for the terminal illness and may re-elect hospice in a new benefit period

Changing hospice providers

You may transfer to a different Medicare-approved hospice once per benefit period. The original hospice must file a discharge notice, and the new hospice must file its own NOE. Both filings must be timely to avoid billing gaps. Confirm with the new hospice that it has submitted the NOE before assuming coverage has transferred.

Appealing a coverage denial or discharge

  1. Request a written explanation from the hospice for any denial or discharge decision
  2. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to initiate a formal appeal
  3. Gather supporting documentation: physician certifications, clinical notes, the hospice election statement and any addendum, and records of services provided
  4. For a discharge you believe is premature, you have the right to request an expedited review by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)
  5. If the initial appeal is denied, you may escalate to a Qualified Independent Contractor (QIC), then to the Office of Medicare Hearings and Appeals (OMHA), and ultimately to federal court

Typical expedited review decisions from a BFCC-QIO are issued within two days of receiving the request. Standard appeals take longer, so acting quickly matters.

Pro Tip: State Health Insurance Assistance Programs (SHIP) provide free, unbiased help navigating Medicare appeals. In Oregon, the SHIBA program (Senior Health Insurance Benefits Assistance) can assign a trained counselor to help you gather documentation and meet appeal deadlines. Call 1-800-722-4134 or visit the Oregon SHIBA website to connect with a local counselor.

Common myths about hospice — and what actually helps

Several persistent misunderstandings lead families to delay hospice election or avoid it entirely. Correcting them can make a real difference in care quality and family wellbeing.

Myth: Hospice is only for the last few days of life. Medicare’s hospice benefit covers two 90-day periods followed by unlimited 60-day periods. Many patients receive hospice for months. Earlier enrollment typically means more time for symptom control, family caregiver support, and access to respite care — all of which are covered under the benefit.

Myth: Electing hospice cancels all your Medicare benefits. It does not. Medicare continues to cover services unrelated to the terminal diagnosis, including treatment for separate conditions like a broken bone or an unrelated infection. Standard deductibles and coinsurance apply to those services, but coverage does not disappear.

Myth: You cannot change your mind. Revocation is always available. Beneficiaries who improve or who want to pursue curative treatment again can revoke hospice election, regain full Medicare coverage, and re-elect hospice later if needed.

Practical tips for families:

  • Keep a physical copy of the signed election statement and any addendum listing services the hospice will not cover; these documents are central to any billing dispute or appeal
  • Confirm the hospice has filed the NOE with Medicare — ask for written confirmation
  • Ask the hospice team which drugs are covered under the hospice plan of care and which fall under Part D for unrelated conditions
  • Verify whether the hospice provides CHC directly or contracts it out; this affects how quickly continuous care is available during a crisis

Pro Tip: Ask the hospice coordinator directly: “Is continuous home care something your staff provides in-house, or do you subcontract it?” If the answer is subcontracted, ask how long it typically takes to arrange. Some hospices cannot mobilize CHC-level care within the same day, which matters enormously when a patient’s symptoms escalate overnight.

Understanding Medicare questions people are afraid to ask can also help families feel more confident having these conversations with hospice staff and physicians.

A perspective on helping families navigate hospice decisions

Hospice conversations are among the hardest ones families face, and the Medicare rules layered on top of them can feel like the wrong thing to focus on in a difficult moment. What I have seen, working with seniors and families in Central Oregon, is that the families who understand the benefit structure before they need it make better decisions under pressure. They know to ask about CHC capability. They know not to drop Part D. They know the election statement is a document worth keeping.

The Medicare hospice benefit is genuinely generous — no deductible, a broad team of covered services, and unlimited benefit periods for patients who continue to qualify. The rules exist to protect both the patient and the program, and understanding them is not a bureaucratic exercise. It is how you make sure the benefit actually works for your family when it matters.

At Mountaintop Insurance, free consultations are available for Central Oregon residents who want to understand how Medicare parts interact with hospice election, what Medigap covers in that context, and how to find a Medicare-approved hospice locally. No sales pressure, no obligation.

Mountaintop Insurance can help you sort out the Medicare details

Sorting out Part A hospice implications, Medigap interactions, and Part D drug coverage is exactly the kind of work Mountaintop Insurance does for Central Oregon residents at no cost. The agency’s free consultations are structured around your specific situation: which Medicare parts you currently have, whether a Medigap policy covers your remaining cost-sharing, and how to locate a Medicare-approved hospice in Deschutes County or the surrounding area.

When you schedule a consultation, bring your Medicare card, any current Medigap or Part D plan documents, and a list of questions about your or your family member’s diagnosis and care goals. The conversation typically covers Part A entitlement confirmation, how hospice election affects your other coverage, and what to expect from the enrollment process.

No high-pressure sales calls, no national call center. Just a local agent who knows Central Oregon’s providers and Medicare’s rules. Schedule a free Medicare consultation to get clear answers before a decision needs to be made.

Sources

These official sources contain the primary rules, forms, and payment data referenced throughout this article:

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

FAQ

Does Medicare pay 100% of hospice care?

Room and board in a nursing facility is not covered by Medicare hospice.

How many days will Medicare pay for hospice?

Medicare covers two initial 90-day benefit periods followed by unlimited 60-day periods, as long as the patient continues to meet the six-month prognosis standard and a physician recertifies eligibility. There is no lifetime day limit on the hospice benefit.

What is the 36-month rule for hospice?

The rule is not a Medicare hospice benefit period rule. It refers to the hospice aggregate payment cap, which limits total Medicare payments to a hospice agency over a cap period based on the number of beneficiaries served. It affects hospice providers’ billing, not individual beneficiary eligibility or coverage duration.

Do you lose Social Security if you go on hospice?

No. Electing the Medicare hospice benefit has no effect on Social Security retirement or disability benefits. Social Security payments continue on their normal schedule regardless of hospice enrollment status.

Disclaimer: This article is for general educational purposes only and does not constitute personalized advice. Medicare rules and plan details change frequently.

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