Medicare Part A covers hospice care when a doctor certifies you have six months or less to live

Yes, Medicare Part A covers hospice — but only under specific conditions. Your doctor must document that you have a terminal illness and a life expectancy of six months or less. The hospice agency must be Medicare-certified. When both conditions are met, Part A pays for the full range of hospice services: nursing care, doctor visits, medications related to your terminal condition, medical equipment, counseling, and aide services. You typically pay nothing for these services.

The catch is that choosing hospice means you are also choosing to stop curative treatment for your terminal condition. Medicare will not pay for treatments meant to cure the illness you entered hospice for — only for comfort care and symptom management. If your condition improves or stabilizes beyond the six-month window, you can leave hospice and return to regular Medicare coverage, or you can be recertified if your doctor still believes you have six months or less to live.

Key Takeaways

  • Medicare Part A covers all hospice services at no cost to you when a doctor certifies a terminal illness with a six-month or shorter life expectancy.
  • The hospice agency must be Medicare-certified; you can ask your doctor or call 1-800-MEDICARE to find one in your area.
  • Choosing hospice means stopping curative treatment for your terminal condition, though you can leave hospice at any time if your condition changes.
  • Part A covers hospice medications, nursing, equipment, counseling, and aide services, but not room and board if you live in a hospice facility (though some facilities waive this).
  • You can be recertified for hospice every 60 days if your doctor still believes you meet the six-month prognosis, even if you live longer than expected.

What Part A actually pays for in hospice

Medicare Part A covers the full cost of routine home hospice care, which is the most common setting. This includes visits from a registered nurse, a doctor, a social worker, and a chaplain or counselor. It covers home health aides who help with bathing and dressing. It covers all medications related to your terminal condition — pain medication, nausea medication, anxiety medication — at no copay. It covers medical equipment like a hospital bed, oxygen, or a wheelchair.

Part A also covers continuous care when you need nursing support around the clock for a short period, usually during a crisis. It covers inpatient respite care — a short stay in a hospice facility or hospital to give your family caregiver a break, typically up to five consecutive days at a time. If you need to be admitted to a hospice facility for symptom management or because home care is no longer possible, Part A covers the facility stay itself, though you may be responsible for room and board charges depending on the facility's policy.

What Part A does not cover: treatments meant to cure your terminal illness, such as chemotherapy or radiation for cancer, or dialysis for kidney failure. It does not cover room and board in a hospice facility unless the facility is part of a hospital or nursing home (policies vary widely, so ask before admission). It does not cover homemaker services like housecleaning or meal preparation, though some hospice agencies offer these as a courtesy.

How to start the hospice process with Medicare

The first step is a conversation with your doctor. Tell them you are interested in hospice care. Your doctor will assess whether you meet the Medicare definition: a terminal illness with a prognosis of six months or less if the disease runs its normal course. This is not a promise that you will die in six months — it is a medical judgment about what is likely. Some people live longer; some live shorter. The point is that your doctor believes you are in the final stage of your illness.

If your doctor agrees, they will refer you to a Medicare-certified hospice agency. You can also ask your doctor for a list of agencies in your area, or you can call 1-800-MEDICARE and ask for hospice providers near you. When you contact an agency, they will send a nurse to your home (or hospital room, or nursing home) to do an intake assessment. This nurse will review your medical history, current medications, and symptoms. They will explain what hospice care involves and answer your questions.

Once you choose an agency, you will sign a consent form. This form states that you understand you are choosing comfort care over curative treatment for your terminal condition. You will also need to sign a form authorizing Medicare to pay the agency directly. The agency handles all billing to Medicare; you do not submit claims yourself. From that point forward, the hospice team coordinates your care.

The difference between Part A hospice and other coverage

If you have Original Medicare (Part A and Part B), Part A covers hospice as described above. Part B does not play a role — Part A is the hospice benefit.

If you have a Medicare Advantage plan (Part C), your plan must cover hospice at the same level as Original Medicare, but the plan may require you to use in-network hospice agencies. Check your plan documents or call your plan to find out which agencies are in-network. If you use an out-of-network agency, you may owe more out of pocket.

If you have Medicaid in addition to Medicare, Medicaid may cover services that Medicare does not — such as homemaker services or room and board in a facility. Ask your hospice agency whether they are enrolled in your state's Medicaid program; many are.

If you have employer retiree coverage or a Medigap policy, those plans do not cover hospice separately — Part A is your primary source. However, a Medigap policy may cover some out-of-pocket costs if they arise.

What happens if you live longer than six months

Living longer than your initial six-month prognosis does not automatically end your hospice coverage. Your doctor can recertify you for hospice every 60 days if they still believe you have a terminal illness and a reasonable expectation of six months or less to live. Many people are recertified multiple times. Medicare does not set a limit on how many times you can be recertified.

However, if your condition improves significantly — for example, if you recover from an acute infection and your underlying illness stabilizes — your doctor may determine that you no longer meet the hospice criteria. In that case, you would be discharged from hospice and return to regular Medicare coverage. You can also choose to leave hospice at any time, for any reason, without penalty. If you later want to return to hospice, you can do so as long as a doctor certifies you again.

Finding a Medicare-certified hospice agency

Not all hospice agencies are Medicare-certified. To receive Part A coverage, the agency must have Medicare certification. You can verify this by calling 1-800-MEDICARE or by visiting the Medicare Care Compare tool at care.cms.gov, where you can search for hospice agencies by location and see their inspection records and quality ratings.

When you are comparing agencies, ask about their service area (some only serve certain zip codes), their availability (24/7 nursing support is standard, but confirm), and whether they have experience with your specific condition. Ask whether they are in-network with your Medicare Advantage plan if you have one. Ask about their bereavement services for your family after you die — many agencies offer counseling and support groups at no cost.

You have the right to choose which agency provides your care. Your doctor can make a referral, but the choice is yours. If you are unhappy with an agency, you can switch to a different one at any time.

Common situations and how Part A covers them

You are in a hospital and your doctor recommends hospice. Part A covers hospice care whether you receive it at home, in a hospital, in a nursing home, or in a hospice facility. The hospital will coordinate with the hospice agency to transfer your care. You do not need to choose between hospital and hospice — you can move between settings as your needs change.

You are already in a nursing home. Part A covers hospice services provided to you in the nursing home. The nursing home staff and the hospice team will work together. The hospice agency typically provides nursing, aides, medications, and equipment; the nursing home provides room and board. You continue to pay the nursing home for room and board as usual.

You want to stay at home but need 24-hour care. Part A covers continuous hospice care at home for short periods when you need round-the-clock nursing. This is more expensive for Medicare than routine home care, so it is typically used during a crisis or the final days. If you need ongoing 24-hour care, the hospice team may recommend inpatient respite care or a facility stay.

Your family caregiver needs a break. Part A covers inpatient respite care — a short stay in a hospice facility or hospital so your caregiver can rest. This is typically covered for up to five consecutive days at a time, and you may be responsible for a small copay (the amount varies by facility).

Frequently Asked Questions

Do I have to choose hospice, or can I keep getting curative treatment?

You do not have to choose hospice. If you want to continue curative treatment, you can. However, once you choose hospice, you are agreeing to stop curative treatment for your terminal condition. You can change your mind and leave hospice at any time to resume curative care, and Medicare will cover that care under Part A and Part B as usual.

What if my doctor says I have six months to live but I live longer?

You can stay on hospice as long as your doctor recertifies you every 60 days and still believes you have a terminal illness with a reasonable six-month prognosis. There is no time limit. Many people are recertified multiple times and live well beyond the initial estimate.

Will I owe anything out of pocket for hospice?

For routine home hospice care covered by Part A, you owe nothing. If you use inpatient respite care, you may owe a small copay (typically $5 per day, capped at five days per benefit period). If you stay in a hospice facility and are charged room and board, you may owe that cost, though many facilities waive it.

Can I use any hospice agency, or does it have to be in my insurance network?

If you have Original Medicare, you can use any Medicare-certified hospice agency. If you have a Medicare Advantage plan, check your plan documents — your plan may require you to use in-network agencies. Call your plan to find out which agencies are in-network in your area.

What if I am in a Medicare Advantage plan — does Part A still cover hospice?

Yes. Medicare Advantage plans must cover hospice at the same level as Original Medicare Part A. However, your plan may have requirements about which agencies you use or how much you pay out of pocket. Contact your plan directly to understand your hospice coverage.