Medicare covers hospice care, but only under specific conditions
Yes, Medicare Part A covers hospice care when your doctor and a hospice medical director both agree you have six months or less to live. Medicare pays for the hospice services themselves — nursing, doctors, medications related to your terminal condition, equipment, and counseling — but you will pay a small amount out of pocket for some items. The key condition is that you must choose hospice care instead of curative treatment for your condition, which means you are shifting from trying to cure the illness to managing comfort and symptoms.
Hospice is covered under Medicare Part A (hospital insurance), not Part B. If you have Original Medicare and are enrolled in Part A, you are already covered. If you have a Medicare Advantage plan, coverage varies by plan, so you will need to check your plan documents or call the plan directly to learn what hospice services are included and what you pay.
Key Takeaways
- Medicare Part A covers hospice when a doctor certifies you have six months or less to live and you choose comfort care over curative treatment.
- You pay nothing for hospice services themselves, but you may pay up to $5 per prescription and up to $5 per day for inpatient respite care, with a maximum of $5 per day for other services.
- Your hospice provider must be Medicare-certified, which you can verify by asking the provider or checking the Medicare Hospice Compare tool online.
- If you change your mind and want curative treatment again, you can revoke hospice and return to regular Medicare coverage, though you lose hospice benefits when ready.
What Medicare actually pays for under hospice
Medicare Part A covers the full cost of core hospice services: registered nurse visits, doctor services, social work, chaplain or spiritual care, and bereavement counseling for your family after you die. It also covers medications prescribed for your terminal condition (not unrelated conditions), medical equipment like oxygen or a hospital bed, and home health aide services.
Inpatient respite care — a short hospital or facility stay to give your family caregiver a break — is also covered. You pay up to $5 per day for respite care, with a maximum of five consecutive days per stay. Physical therapy, occupational therapy, and speech therapy related to your terminal condition are covered at no cost to you.
The hospice provider bills Medicare directly for these services. You do not submit claims or pay upfront and then seek reimbursement.
What you pay out of pocket
Your costs under Medicare hospice are capped and small. You pay up to $5 per prescription for medications related to your terminal condition. You pay up to $5 per day for inpatient respite care. For any other services — such as durable medical equipment or supplies — you pay up to $5 per day, but your total out-of-pocket cost cannot exceed $5 per day across all categories combined.
If you have a Medigap (supplemental insurance) policy, it may cover some or all of these small copayments, depending on the plan. Check your Medigap policy or call your supplemental insurance company to confirm.
Medications for conditions unrelated to your terminal illness are not covered under hospice. Those are covered under your regular Part D prescription drug plan if you have one, and you pay your normal Part D copayments.
How to start hospice through Medicare
Your doctor must refer you to hospice. The doctor will order a hospice evaluation, during which a hospice nurse and doctor will meet with you to discuss your condition, goals, and what hospice services can provide. If you and the hospice medical director agree that hospice is right for you, the hospice provider will handle the Medicare paperwork.
You must sign a consent form stating that you understand hospice is for comfort care, not curative treatment. You also choose whether to receive hospice at home, in a hospice facility, in a hospital, or in a nursing home. Most hospice care happens at home.
The hospice provider must be Medicare-certified. You can ask the provider directly whether they are certified, or you can search the Medicare Hospice Compare tool on Medicare.gov to verify the provider's name and location.
What happens if you change your mind
You can revoke hospice care at any time and return to curative treatment covered by Medicare. When you revoke, hospice benefits stop when ready. Regular Medicare coverage for your condition resumes, and you can pursue treatment aimed at curing or managing your illness again.
If you revoke hospice and later want to return to it, you can do so, but your doctor and the hospice medical director must recertify that you meet the six-month prognosis again. Some people move in and out of hospice as their condition changes.
Medicare Advantage plans and hospice coverage
If you are enrolled in a Medicare Advantage plan (Part C), hospice coverage is different. Medicare Advantage plans must cover hospice services, but the copayments, coinsurance, and which providers are in-network may vary. Some plans cover hospice at no cost; others charge copayments.
Contact your Medicare Advantage plan before choosing a hospice provider to learn what you will pay and whether your preferred provider is covered. If your preferred hospice is not in your plan's network, you may still use it, but your costs could be higher.
Frequently Asked Questions
Can I use hospice and still see my regular doctor?
Yes. Your regular doctor can continue to see you, and the hospice team coordinates care with them. However, your primary focus shifts to comfort and symptom management rather than curative treatment. If you want aggressive treatment to cure your condition, that conflicts with hospice goals and you would need to revoke hospice first.
Does Medicare cover hospice in a nursing home or assisted living?
Medicare covers hospice services in a nursing home if you are a resident there. Hospice can also be provided in assisted living, though coverage and coordination vary. Ask your facility and your hospice provider how they will work together before you start services.
What if my doctor says I have more than six months to live?
Medicare requires a six-month prognosis or less. If your doctor believes you will live longer, you do not meet Medicare's requirement for hospice. If your condition worsens later and the prognosis changes to six months or less, you can be referred to hospice at that time.
Do I lose my Medicare coverage if I choose hospice?
No. You keep your Medicare Part A coverage. Hospice is a covered benefit under Part A. If you revoke hospice, your regular Medicare benefits resume when ready. You do not lose coverage by choosing hospice.
Will hospice help with pain management?
Yes. Pain management and symptom control are core goals of hospice. The hospice team includes doctors and nurses trained in managing pain and other symptoms at the end of life. Medications for pain and other symptoms related to your terminal condition are covered by Medicare.