Who qualifies for hospice under Medicare?
You qualify for the Medicare hospice benefit when you have Part A and meet three conditions. First, your hospice doctor and your regular doctor, if you have one, certify that you are terminally ill with a life expectancy of 6 months or less. Second, you accept comfort care, also called palliative care, instead of treatment intended to cure your illness. Third, you sign a Hospice Election Statement choosing hospice instead of other Medicare covered treatments for your terminal illness and related conditions. That statement names the hospice providing your care, your chosen attending doctor, and your start date, and it must be completed before services begin. Living past 6 months does not end your coverage. You can keep receiving hospice care as long as the hospice medical director or hospice doctor recertifies that you are still terminally ill after a face to face meeting with a hospice doctor or nurse practitioner.
What do you pay for hospice care with Medicare?
You pay nothing for covered hospice services when you use a Medicare approved hospice provider. There is no separate premium and no deductible for the hospice benefit itself. Two small costs can apply. You may pay a copayment of up to $5 for each prescription for outpatient drugs used for pain relief and symptom control at home. You may also pay 5 percent of the Medicare approved amount for inpatient respite care, and that amount can never exceed the Part A inpatient hospital deductible, which is $1,736 in 2026. Original Medicare still pays for health problems unrelated to your terminal illness, though normal deductibles and coinsurance apply to that care. If you live in a facility such as a nursing home and choose hospice, you may still owe room and board. Your hospice provider must tell you in writing if any drug or service is not covered and why.
How long does Medicare pay for hospice?
Medicare pays for hospice as long as your doctor certifies that you remain terminally ill, and there is no lifetime limit. Coverage is organized into benefit periods: two 90 day periods, followed by an unlimited number of 60 day periods. After your first 6 months of care, the hospice medical director or hospice doctor must recertify that your life expectancy is still 6 months or less, based on a face to face meeting with a hospice doctor or hospice nurse practitioner. You also have the right to change your hospice provider once during each benefit period. Hospice is not a one way door. If your health improves or your illness goes into remission, you can stop hospice care at any time, return to the coverage you had before, and elect hospice again later if you qualify. Many families find that knowing this makes the decision to start hospice less frightening.
Where can you receive hospice care?
Most people receive Medicare hospice care at home, because the benefit follows you wherever you live. That includes a private home, an assisted living facility, or a nursing home. If you meet certain conditions, you can also get care in an inpatient hospice facility. The hospice team comes to you: nurses, hospice aides, social workers, counselors, chaplains, and trained volunteers, working with the hospice doctor and, if you choose, your own doctor or nurse practitioner as the attending medical professional. When short term inpatient care is needed for pain or symptom management, your hospice team must arrange the stay and Medicare covers it, and the same is true for inpatient respite care. One important caution: if you ever need hospital care, let your hospice team make the arrangements first. If they do not, you might be responsible for the entire cost of that hospital stay.
What does Medicare hospice not cover?
Once your hospice benefit starts, Medicare will not cover treatment intended to cure your terminal illness or related conditions, and it will not cover prescription drugs meant to cure your illness rather than control pain or symptoms. Care from providers your hospice team did not arrange is not covered, because all care for your terminal illness must be given or coordinated by the hospice you chose. Medicare also does not pay room and board when you receive hospice at home or live in a nursing home or hospice residence, although it does cover facility stays for short term inpatient care and respite care that the team arranges. Emergency room visits, inpatient hospital care, and ambulance rides are not covered unless the hospice team arranges them or they are unrelated to your terminal illness. Always contact your hospice team before getting any of these services, or you could owe the full cost.
| Covered by the Medicare hospice benefit | Not covered once hospice starts |
|---|---|
| Doctors' services, nursing, and medical care | Treatment intended to cure the terminal illness |
| Drugs for pain and symptom management, up to $5 copay each | Prescription drugs intended to cure the illness |
| Durable medical equipment and medical supplies | Room and board at home, in a nursing home, or in a hospice residence |
| Hospice aide and homemaker services | Care from providers your hospice team did not arrange |
| Physical, occupational, and speech therapy | ER visits, hospital stays, and ambulance rides not arranged by the team |
| Social services, dietary counseling, spiritual and grief counseling | Curative treatment from a second hospice you did not elect |
| Short term inpatient care and respite care, 5 percent coinsurance for respite |
Source: Medicare.gov, Hospice Care Coverage, verified August 2026.
How does hospice work with Medicare Advantage?
Hospice is always paid through Original Medicare Part A, even if you are enrolled in a Medicare Advantage plan. When you elect hospice, Original Medicare covers everything related to your terminal illness, and you can stay in your plan as long as you keep paying its premiums. Your plan continues to cover extra benefits like dental and vision, plus care unrelated to your terminal illness, and it must help you find a Medicare approved hospice in your area. For a few years a CMS demonstration called the VBID hospice benefit component let some Medicare Advantage plans cover hospice directly, but CMS ended that carve in on December 31, 2024. Since January 1, 2025, hospice for every Medicare Advantage enrollee runs through Original Medicare again. If you later leave hospice care, your plan coverage starts again the first day of the following month.
You do not have to figure this out alone
Choosing hospice for yourself or someone you love is one of the hardest decisions a family makes. The Medicare paperwork should be the easiest part of it. Lara Goulson is an independent licensed insurance agent. She helps families understand exactly how the hospice benefit works with their coverage, what it will and will not cost, and what changes if you are in a Medicare Advantage plan. Her help is always free, with no obligation, in English, Spanish, or Hebrew.
Call or text (818) 472-5484. A ten minute conversation can take the Medicare questions off your family's plate.
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