Medicare covers in-home hospice care when a doctor certifies that you have six months or less to live, but only through Medicare Part A (hospital insurance). The program pays for nursing visits, aide services, medications related to your terminal condition, medical equipment, and counseling — but not room and board or 24-hour live-in care.
Key Takeaways
- Medicare Part A pays the full cost of hospice services with no deductible, but your doctor and the hospice medical director must both certify that your condition is terminal.
- Covered services include nursing, home health aides, social work, chaplain visits, bereavement counseling, and medications for pain and symptom management.
- You cannot receive curative treatment (treatment meant to cure the illness) and hospice at the same time under Medicare.
- If you live in a nursing home or assisted living facility, Medicare hospice still covers the hospice services, though the facility may charge a daily room-and-board fee.
- You can stop hospice care at any time and return to regular Medicare coverage, or switch to a different hospice provider.
What In-Home Hospice Services Medicare Covers
Medicare Part A covers the medical side of hospice completely — you pay nothing out of pocket for the services themselves. This includes skilled nursing visits to manage pain, monitor your condition, and teach family members how to help. It also covers home health aide services for bathing, dressing, toileting, and other personal care.
The program also pays for medications related to your terminal illness and symptom management, medical equipment like oxygen, hospital beds, wheelchairs, and walkers, and medical supplies such as wound dressings and catheters. Hospice covers social work services to help with practical and emotional needs, chaplain or spiritual counseling if you want it, and bereavement counseling for your family for up to 13 months after your death.
Physical therapy, occupational therapy, and speech therapy are covered if they help with comfort and function rather than cure. Hospice also provides respite care — a short inpatient stay (usually up to five days) to give family caregivers a break, though Medicare covers only 80 percent of the cost after you meet your Part A deductible for that benefit period.
What Medicare Hospice Does Not Cover
Medicare does not pay for room and board — the cost of your home, rent, or assisted living facility charges. If you are in a nursing home or assisted living, the facility continues to charge its daily rate, and Medicare hospice covers only the medical services on top of that.
Medicare hospice does not cover 24-hour live-in care or continuous care at home. If you need round-the-clock supervision, you would need to arrange and pay for private caregivers or move to an inpatient hospice facility (which Medicare does cover if the hospice operates one).
Once you choose hospice, Medicare stops paying for curative treatment — treatment meant to cure or slow your terminal illness. This includes chemotherapy, dialysis, surgery for the terminal condition, and antibiotics for infections (though comfort-focused antibiotics may be used). If you want to pursue treatment again, you must formally leave the hospice program and return to regular Medicare coverage.
How to Start Medicare Hospice at Home
Your doctor must refer you to a hospice program and document that you have a terminal illness with a life expectancy of six months or less. The hospice medical director reviews this information and must agree with the diagnosis. You then sign a consent form stating that you understand you are choosing comfort care over curative treatment.
You can choose any Medicare-certified hospice program in your area. Your doctor can recommend one, or you can search the Medicare Hospice Compare tool on Medicare.gov to see which programs serve your location and read their inspection records. Once you choose a program, the hospice handles all coordination with Medicare — you do not need to file paperwork yourself.
The hospice will ask about your insurance, living situation, and medical history. If you are in a nursing home or assisted living facility, the hospice works with that facility's staff. If you are at home, the hospice schedules visits based on your needs, which may range from once a week to several times a week depending on your condition.
Costs You May Still Have
You are responsible for a five-percent coinsurance on medications and respite care. For most people, this is a small amount — a month's supply of pain medication might cost $5 to $15 out of pocket. Respite care coinsurance is typically $150 to $200 for a five-day stay, depending on the facility.
If you have a Medigap (supplemental insurance) or Medicare Advantage plan, check whether it covers hospice coinsurance. Many Medigap plans cover the five percent, which would leave you with no out-of-pocket cost for hospice services.
You may also choose to hire private caregivers or aides beyond what hospice provides — for example, if you want someone present overnight when hospice does not schedule a visit. This is entirely your choice and your expense; Medicare does not cover it.
Switching Hospice Providers or Stopping Hospice
You can change to a different Medicare-certified hospice program at any time without penalty. straightforward tell your current hospice that you are leaving and contact the new program. The new program handles the transfer with Medicare.
You can also stop hospice care and return to regular Medicare coverage if your condition improves or if you decide you want to pursue curative treatment again. Your doctor and the hospice medical director must document the change. Once you leave hospice, Medicare resumes paying for all covered services under your regular benefits — though you will start a new benefit period, which may affect your deductible.
If you are readmitted to hospice later, Medicare treats it as a new election, and you begin a new benefit period. You can move between hospice and regular Medicare coverage as many times as needed.
Hospice in Nursing Homes and Assisted Living
If you live in a nursing home or assisted living facility, you can still receive Medicare hospice services. The hospice sends nurses, aides, social workers, and other staff to visit you at the facility. Medicare pays the hospice for these services just as it would if you were at home.
However, the nursing home or assisted living facility continues to charge its daily room-and-board rate. Medicare hospice does not cover that cost. You or your family pays the facility directly, or Medicaid covers it if you are Medicaid-may be able to access. The hospice and the facility coordinate care, but they are separate bills.
Frequently Asked Questions
Does my doctor have to refer me to hospice, or can I ask for it myself?
You can ask your doctor about hospice, but your doctor must make the referral and document the terminal diagnosis for Medicare to cover it. If your doctor is unwilling, you can seek a second opinion from another physician, or ask the hospice program to contact your doctor directly to discuss whether hospice is appropriate for your condition.
What happens if I live longer than six months?
Medicare can continue to cover hospice as long as the hospice medical director recertifies every 60 days that your condition remains terminal. Some people do live longer than the initial six-month estimate. You remain on hospice and continue to receive covered services at no cost.
Can I use Medicare Advantage instead of Original Medicare for hospice?
No. Hospice is covered only through Medicare Part A (Original Medicare). If you are enrolled in a Medicare Advantage plan, you must switch to Original Medicare to use hospice. You can switch during the hospice election period without waiting for the annual enrollment period.
Will hospice tell my family that I am dying?
Hospice staff will discuss your prognosis honestly with you and your family if you want them to. They do not make that decision for you — you control what information is shared and with whom. Many families find these conversations helpful for planning and saying goodbye.
Can I change my mind about hospice if I want treatment again?
Yes. You can leave hospice at any time and return to regular Medicare coverage, including curative treatment. Tell your hospice program and your doctor that you want to stop. Medicare will resume paying for all covered services under your regular benefits in a new benefit period.