Medicare covers hospice care when a doctor says you have six months or less to live
Medicare Part A pays for hospice care without a copay or deductible, as long as you meet the conditions. You must be enrolled in Medicare Part A, have a doctor and hospice medical director certify that you are terminally ill, and choose hospice care instead of curative treatment for your condition. Medicare will cover the full cost of hospice services — nursing, doctors, medications related to your terminal illness, equipment, and counseling — with no out-of-pocket costs to you.
The "six months or less" rule is not a hard important date. It means your doctor believes that is the likely timeframe, but people sometimes live longer. If you do, Medicare can continue to cover your hospice care as long as your doctor recertifies that you still meet the criteria. You can also change your mind and leave hospice to pursue other treatment; Medicare will cover that too.
Key Takeaways
- Medicare Part A covers all hospice services with no copay, deductible, or prior authorization needed once your doctor certifies terminal illness.
- You must choose hospice care instead of curative treatment for your terminal condition, though you can change this choice at any time.
- Hospice covers nursing, doctor visits, medications for your terminal illness, equipment, counseling, and inpatient care if needed — but not unrelated medical care.
- The six-month prognosis is a medical estimate, not a important date; Medicare continues coverage as long as your doctor recertifies you meet the criteria.
- If you have Medicaid or a Medigap or Medicare Advantage plan, those programs may cover costs hospice does not, such as unrelated medical care.
What Medicare hospice coverage includes
Medicare Part A pays for routine home hospice care, which is the most common type. This covers a nurse visiting your home, a doctor overseeing your care, a social worker, a chaplain or counselor, home health aides, medical equipment like oxygen or a hospital bed, and medications for your terminal illness. It also covers short-term inpatient respite care — a few days in a facility so your family caregiver can rest — and continuous care at home if your symptoms become hard to manage.
If you need inpatient hospice care because symptoms cannot be controlled at home, Medicare covers that too. This might be in a hospice facility, a hospital, or a nursing home. The coverage includes all the same services plus room and board while you are there.
Bereavement counseling for your family is covered for up to one year after your death, even though you will not be alive to receive it. This is a service Medicare provides to your family members.
What Medicare hospice coverage does not include
Medicare hospice does not pay for treatment meant to cure your terminal illness. Once you choose hospice, Medicare stops covering chemotherapy, radiation, dialysis, surgery, or other curative care for that condition. If you want to try a new treatment, you must leave hospice first.
Hospice also does not cover medical care for conditions unrelated to your terminal illness. If you have diabetes, heart disease, or another separate condition, Medicare Part B covers doctor visits and treatments for those — but you pay the Part B copay and deductible as usual. Some medications for unrelated conditions may not be covered by hospice either.
Room and board costs are not covered if you live in a nursing home or assisted living facility. Hospice covers the hospice services you receive there, but you still pay the facility's daily rate.
How to start hospice through Medicare
Your doctor must refer you to hospice. You cannot start hospice on your own; a physician has to believe you meet the criteria and make the referral. If your current doctor has not mentioned hospice, you can ask them whether it might be right for you, or you can ask for a referral to a palliative care doctor who can discuss the option.
Once you have a referral, you choose a Medicare-certified hospice agency. You can ask your doctor for recommendations, or you can call your state hospice organization to find agencies in your area. The hospice agency will explain what services they provide, where care will happen, and what to expect. You do not have to use the agency your doctor recommends; the choice is yours.
When you are ready, you sign a form saying you choose hospice care for your terminal condition. This form goes to Medicare. There is no waiting period; coverage starts once Medicare receives the signed form and your doctor's certification.
How long Medicare covers hospice
Medicare covers hospice in benefit periods. The first period is 90 days. After that, you get a second 90-day period. After that, you get unlimited 60-day periods for as long as your doctor recertifies that you still meet the criteria.
At the end of each period, your hospice doctor and the hospice medical director review your condition. If they believe you still have a terminal illness and meet the criteria, they recertify you and coverage continues. If your condition improves or changes, they may recommend leaving hospice, or you can choose to leave on your own.
There is no limit to how many times Medicare will recertify you. Some people receive hospice care for months or even longer than a year. The key is that your doctor must believe the prognosis is still six months or less.
If you have other insurance along with Medicare
If you have Medicaid in addition to Medicare, Medicaid may cover costs that Medicare hospice does not — such as medications for unrelated conditions or room and board in a facility. Contact your state Medicaid office to ask what hospice-related costs they cover.
If you have a Medigap policy (supplemental insurance), it does not cover hospice because Medicare already covers hospice with no copay or deductible. Medigap policies are designed to cover the copays and deductibles that Medicare does not pay, and there are none in hospice.
If you have a Medicare Advantage plan (Part C), you must use a hospice agency that is in your plan's network, or your plan may not cover it. Call your Medicare Advantage plan to ask which hospice agencies are in network before you choose one. Once you enroll in hospice, your Medicare Advantage plan ends and you return to Original Medicare for all services.
What to ask your doctor about hospice
If your doctor has not mentioned hospice but you think it might be right for you or a family member, here are questions to ask:
- Do you think I have a terminal illness with a prognosis of six months or less?
- What would hospice care look like for me — where would it happen, and what services would I receive?
- Can I still see my current doctors, or would I switch to the hospice team?
- If I choose hospice and then change my mind, can I leave and go back to curative treatment?
- Do you have hospice agencies you recommend, or can you refer me to one?
When to call Medicare or your hospice agency
Call Medicare at 1-800-MEDICARE (1-800-633-4227) if you have questions about what hospice services are covered, how much you will pay, or whether you meet the criteria. Call your hospice agency directly if you have questions about the care you are receiving, need to schedule a visit, or want to discuss changing your care plan.
If you believe Medicare is not covering a service that should be covered, ask your hospice agency to file an appeal on your behalf. You can also file an appeal yourself by calling 1-800-MEDICARE.
Frequently Asked Questions
Can I get hospice care at home, or do I have to go to a facility?
Most hospice care happens at home, and Medicare covers it there. You can also receive hospice in a nursing home, assisted living facility, hospital, or dedicated hospice facility — Medicare covers the hospice services in all these settings. The choice depends on your needs and what your family can manage.
What happens to my Medicare Part B coverage when I choose hospice?
Medicare Part B stays active. You can still see doctors for unrelated conditions and pay the usual copays and deductibles. However, you cannot receive curative treatment for your terminal illness through Part B — that is the trade-off of choosing hospice.
If I leave hospice, do I have to wait to rejoin later?
No. You can leave hospice at any time and go back to curative treatment. If you change your mind again and want hospice, you can rejoin as long as your doctor still believes you meet the criteria. Each time you rejoin, a new benefit period starts.
Does Medicare cover hospice for children?
Yes. Children with terminal illnesses can receive Medicare hospice if they are enrolled in Medicare and meet the criteria. The services are the same, though pediatric hospice agencies may have staff trained in caring for children.
Who decides if I meet the six-month prognosis — my doctor or Medicare?
Your doctor and the hospice medical director decide together. Medicare does not review the prognosis before coverage starts. However, if Medicare later questions whether you met the criteria, they can audit the case and ask for medical records to support the decision.