Medicare covers inpatient hospice care for as long as your doctor says you need it, with no set time limit
Medicare Part A pays for inpatient hospice care in a hospital or hospice facility when a doctor certifies that you are terminally ill and have six months or less to live if the illness runs its normal course. Unlike some other Medicare services that have a fixed number of days covered, inpatient hospice has no maximum number of days. You can stay as long as your condition requires and your doctor continues to certify that hospice care is medically necessary.
The key is the certification. Your doctor must recertify your need for hospice care at specific intervals — initially after 5 days, then after 30 days, then every 60 days after that. As long as these recertifications happen and your condition still meets the hospice criteria, Medicare continues to pay. If you improve enough that your doctor no longer certifies you as terminally ill, coverage stops.
Key Takeaways
- Medicare Part A covers inpatient hospice care with no maximum number of days, as long as your doctor recertifies your need at required intervals.
- Your doctor must certify that you are terminally ill with six months or less to live, and must recertify after 5 days, 30 days, and every 60 days after that.
- If you improve and no longer meet the hospice criteria, your doctor will not recertify and Medicare coverage ends.
- You pay nothing out of pocket for inpatient hospice care covered by Medicare Part A, including room, meals, and medications related to your terminal condition.
- If you leave hospice and later need it again, your doctor can re-enroll you and Medicare will cover it again.
What the doctor's certification actually means
The six-month prognosis is not a prediction of exactly when you will die. It is a medical judgment that, based on your condition, you are more likely than not to live six months or less if your illness continues without change. Some people live longer than six months after being enrolled in hospice, and some live shorter. Medicare allows continued coverage as long as your doctor believes the prognosis remains accurate.
Your doctor does not have to be a hospice doctor to make the initial certification. Your regular physician, a specialist, or a hospital doctor can certify that you meet hospice criteria. Once you are enrolled, the hospice medical director and your attending physician (which may be your own doctor or a hospice doctor) handle the recertifications.
The recertification schedule and what happens if it lapses
After your initial enrollment, your doctor must recertify your need for hospice within 5 days. Then a recertification is due within 30 days of enrollment. After that, recertifications are due every 60 days. These are not optional — they are required for Medicare to keep paying.
If a recertification is missed or late, Medicare may deny payment for the days after the important date until a new certification is submitted. The hospice agency is responsible for tracking these dates and making sure recertifications happen on time, but it is worth asking your hospice care team about the schedule so you know when to expect these reviews.
If your condition improves and your doctor determines you no longer meet the hospice criteria — for example, if a cancer goes into remission or an infection clears — your doctor will not recertify. Your hospice coverage ends, though you can be re-enrolled later if your condition changes again.
What Medicare Part A pays for in inpatient hospice
Medicare covers all costs related to your terminal illness while you are in an inpatient hospice facility or hospital bed designated for hospice care. This includes your room, meals, nursing care, medications for pain and symptom management, medical equipment, counseling, and social services. You do not pay a copay, coinsurance, or deductible for any of these services.
The only costs you may owe are for services not related to your terminal condition — for example, if you need treatment for an unrelated acute illness. Those costs would be handled under regular Medicare rules, not hospice rules.
The difference between inpatient hospice and home hospice
Inpatient hospice means you are staying in a facility — either a dedicated hospice facility, a hospital, or a skilled nursing facility with a hospice unit. Home hospice means you receive care at your own home, with hospice staff visiting you. Medicare covers both, but the rules are slightly different.
p>With home hospice, Medicare covers an unlimited number of visits and services, with no time limit. You can receive home hospice for as long as your doctor recertifies your need. Inpatient hospice also has no time limit, but it is more expensive for Medicare and is typically used when pain or symptoms cannot be managed at home, or when you need 24-hour care.Some people move between inpatient and home hospice during their illness. For example, you might start at home, move to inpatient care during a crisis, and return home later. Each setting has its own coverage rules, but both are covered as long as your doctor recertifies.
What to ask your doctor and hospice team
Before you enroll in inpatient hospice, ask your doctor: "Do you believe I meet the criteria for hospice care?" and "How often will you need to recertify my condition?" This helps you understand the plan and know what to expect.
Ask your hospice team: "What is the schedule for recertifications?" and "What happens if my condition improves?" You should also ask whether the facility is Medicare-certified, because only Medicare-certified hospice providers can bill Medicare directly.
If you are unsure whether inpatient hospice is the right choice for you, ask whether you can try home hospice first, or whether you can move between settings. Many people find that having options reduces anxiety about the decision.
When to contact Medicare or your hospice provider
Contact your hospice provider right away if you believe your condition has improved significantly or if you want to stop hospice care. They will work with your doctor to determine whether a recertification is still appropriate.
If you have questions about whether a service is covered or whether you owe any costs, call Medicare at 1-800-MEDICARE (1-800-633-4227). They can tell you whether a specific service or medication is covered under your hospice benefit.
If you believe Medicare has denied a service that should be covered, you have the right to appeal. Your hospice provider can help you file an appeal, or you can contact Medicare directly to start the process.
Frequently Asked Questions
Can I be on hospice for longer than six months?
Yes. The six-month prognosis is not a important date. As long as your doctor recertifies that you still meet the hospice criteria, Medicare continues to pay, even if you live longer than six months. Some people are on hospice for a year or more.
What happens if I improve and want to leave hospice?
You can stop hospice care at any time. If you improve enough that your doctor no longer certifies you as terminally ill, your coverage ends. If your condition worsens again later, your doctor can re-enroll you and Medicare will cover it again from that point forward.
Do I have to pay anything out of pocket for inpatient hospice?
No. Medicare Part A covers all costs related to your terminal illness — room, meals, medications, nursing, and services. You pay nothing for hospice care itself. You may owe costs only for treatment of conditions unrelated to your terminal illness.
What if my doctor does not recertify on time?
If a recertification is late, Medicare may not pay for the days after the important date until a new certification is submitted. Your hospice provider is responsible for tracking these dates, but ask them about the schedule to make sure recertifications are happening on time.
Can I switch between inpatient and home hospice?
Yes. Many people move between settings during their illness. Both are covered by Medicare as long as your doctor recertifies your need. Ask your hospice team about the process if you want to change settings.