Medicare covers hospice care at home under Part A, and you do not pay a copay or coinsurance for most hospice services
Yes, Medicare Part A covers hospice care delivered in your home. You pay nothing for the hospice services themselves — no copay, no coinsurance, no deductible. Medicare pays the hospice agency directly. The only costs you may see are a small copay (up to $5) for prescription drugs and a 5 percent coinsurance if you choose an inpatient respite stay, which is a short hospital admission to give your family a break from caregiving.
To receive hospice at home through Medicare, your doctor and a hospice medical director must agree that you have a terminal illness and six months or less to live. This does not mean you will die in exactly six months — some people live longer, and hospice can continue as long as your doctor recertifies that the condition remains terminal. Hospice is about comfort and quality of life, not curative treatment.
You must be enrolled in Medicare Part A to use this benefit. If you have a Medicare Advantage plan (Part C), you still have access to hospice through Medicare Part A, even though your regular medical care runs through your Advantage plan.
Key Takeaways
- Medicare Part A covers all hospice services at home with no copay or coinsurance for the hospice care itself.
- Your doctor and the hospice medical director must both agree you have a terminal illness with six months or less to live.
- Hospice covers nursing visits, aide services, medications for comfort, equipment, counseling, and spiritual care — whatever supports your comfort at home.
- You can change hospice providers or stop hospice at any time, and your regular Medicare coverage for other conditions continues alongside hospice.
- Medicare Advantage members can use hospice through Part A even though their regular care is managed by their Advantage plan.
What Medicare Hospice at Home Actually Covers
Medicare hospice covers the full range of services needed to keep you comfortable at home. This includes nursing visits (as often as needed), home health aide services for personal care, medications related to your terminal condition, medical equipment like oxygen or a hospital bed, and supplies like bandages or catheters. Hospice also covers counseling — for you and your family — plus spiritual care if you want it, and bereavement support for your family after you die.
What hospice does not cover is treatment meant to cure your illness. If you are on hospice for advanced cancer, Medicare will not pay for chemotherapy or radiation through the hospice benefit. However, if you develop a separate, unrelated condition — say you break your arm — your regular Medicare Part A and Part B coverage continues, and you can receive treatment for that injury outside of hospice.
The hospice team coordinates your care and works with your regular doctors. Your primary care doctor does not stop being your doctor; the hospice team works alongside them. If you need hospital care for something unrelated to your terminal condition, you can go to the hospital, and Medicare covers it as usual.
How to Start Hospice Through Medicare
The process begins with your doctor. Your doctor must refer you to hospice and document that you have a terminal illness with a prognosis of six months or less. You then choose a Medicare-certified hospice agency. You can ask your doctor for recommendations, or you can call your local Area Agency on Aging (find yours at eldercare.acl.gov) or dial 211 to get a list of hospice providers in your area.
Once you choose an agency, the hospice medical director reviews your medical records and meets with you (or your family if you cannot communicate). Both your doctor and the hospice medical director must sign off on the hospice plan. This usually takes a few days to a week. After that, the hospice team begins visiting your home according to a schedule you set with them.
You do not need to be homebound to receive hospice at home, though most people are. If you can leave your home, you can still receive hospice services there. Hospice is flexible — the team comes to you on a schedule that works for your situation.
What You Pay and What Medicare Pays
Medicare Part A pays the hospice agency a set daily rate for your care. You pay nothing for that rate — no copay, no coinsurance. The only out-of-pocket costs you may face are a copay up to $5 per prescription for comfort medications (such as pain relievers or anti-nausea drugs) and a 5 percent coinsurance if you choose an inpatient respite stay.
An inpatient respite stay is a short admission to a hospital or hospice facility — usually a few days — to give your family a break from caregiving. Medicare covers this, and you pay 5 percent of the cost. Most families do not use respite care, so this cost does not explore to everyone.
If you have a Medigap or Medicaid plan, it may cover some or all of your hospice copays and coinsurance. Check your plan documents or call your plan to ask what hospice costs they cover.
Hospice and Your Other Medicare Coverage
Being on hospice does not stop your other Medicare benefits. Your Part B coverage continues, so if you need to see a specialist for an unrelated condition, Medicare covers it. Your Part A coverage for hospital and skilled nursing care continues for conditions unrelated to your terminal illness. If you have prescription drug coverage (Part D), it stays active.
However, while you are on hospice, Medicare does not pay for curative treatment of your terminal condition through regular Part A and Part B. For example, if you are on hospice for heart failure, Medicare will not pay for a heart transplant evaluation or aggressive medications meant to reverse the condition. The hospice benefit is designed to replace curative care for your terminal illness, not to run alongside it.
If you decide to stop hospice and pursue curative treatment instead, you can do that. You straightforward tell the hospice agency you want to stop, and your regular Medicare coverage for that condition resumes. There is no penalty for changing your mind.
Changing or Stopping Hospice
You can switch to a different hospice agency at any time. If you are unhappy with your current provider, you can call another agency and ask them to take over your care. The new agency handles the paperwork with Medicare. You do not need your doctor's permission to switch agencies, though your doctor should know about the change.
You can also stop hospice entirely and go back to curative treatment if your condition improves or if you change your mind about your goals. When you stop, your regular Medicare coverage for your condition resumes when ready. If your condition worsens again and you want to return to hospice, you can — your doctor and a hospice medical director will need to recertify that you still meet the criteria.
Some people move between hospice and hospital care. If you are admitted to the hospital, you automatically stop receiving hospice services during the hospital stay. When you are discharged, you can restart hospice if you still meet the criteria, or you can stay with regular Medicare coverage.
Medicare Advantage and Hospice
If you are enrolled in a Medicare Advantage plan (Part C), you still have the right to use Medicare hospice. Hospice is a Part A benefit, and it is not managed by your Advantage plan. When you choose hospice, your hospice care is covered by Medicare Part A directly, not by your Advantage plan.
Your Advantage plan continues to cover your other medical needs while you are on hospice. If you need treatment for a condition unrelated to your terminal illness, your Advantage plan covers it as usual. However, for your terminal condition, the hospice benefit takes over, and your Advantage plan does not pay for curative treatment of that condition.
Some Advantage plans have contracts with specific hospice agencies. If your plan has preferred providers, you can still choose any Medicare-certified hospice agency — your plan cannot force you to use their preferred provider. You have the right to choose.
Questions to Ask Your Doctor
Before you start hospice, ask your doctor these questions: What is my diagnosis, and why do they think I have six months or less to live? What symptoms or changes should I expect? What comfort measures can hospice provide? Can I continue seeing my regular doctors while on hospice? What happens if my condition improves or if I want to stop hospice? Will my medications change, and what will they cost? Can my family stay involved in my care plan?
Also ask: Does the hospice agency work with my doctor, or will I need a new medical director? Can I choose which hospice agency I use? What services does the agency provide, and how often will they visit? These answers help you understand what to expect and whether a particular hospice agency is a good fit for you.
Frequently Asked Questions
Do I have to be homebound to receive hospice at home?
No. While most hospice patients are homebound, you do not have to be. If you can leave your home, you can still receive hospice services there. The hospice team visits you at home on a schedule you agree to, and you can go out if you are able.
What if I live in a nursing home or assisted living facility?
Hospice can be provided in nursing homes and assisted living facilities. Medicare covers it the same way — the hospice team visits the facility to provide care. The facility staff and hospice staff work together to support you. You still pay nothing for the hospice services themselves.
Can my family be trained to help with my care?
Yes. Hospice teams teach family members how to provide basic comfort care, manage medications, and recognize changes in your condition. This training is part of the hospice service and is covered by Medicare. Many families find this helps them feel more involved and prepared.
What if I outlive the six-month prognosis?
You can stay on hospice as long as your doctor recertifies that your condition remains terminal. There is no time limit. If your condition improves significantly and is no longer considered terminal, your doctor and the hospice medical director may recommend stopping hospice, but that decision is made together with you.
Does hospice mean I am giving up on treatment?
Hospice means shifting the focus from curative treatment to comfort and quality of life. You are not giving up — you are choosing a different kind of care. Many people find that hospice allows them to spend time with family, manage pain better, and live more fully in the time they have left.