Medicare Part B does not pay for hospice care itself — Medicare Part A does
If you are enrolled in Original Medicare and need hospice, your coverage comes through Medicare Part A, not Part B. Part B covers doctor visits and outpatient services. Hospice is an inpatient benefit, so it falls under Part A's hospital insurance.
This matters because it changes what you pay and which paperwork you need. Part A covers the full cost of hospice care — the nurse visits, the medications for comfort, the equipment, the social worker and chaplain services — with no copay or coinsurance. You pay nothing out of pocket for hospice services themselves once Part A has approved the claim.
If you are in a Medicare Advantage plan (Part C), your hospice coverage works differently. Some Advantage plans cover hospice through their own network, while others revert you back to Original Medicare Part A for hospice only. You need to check your plan documents or call your plan to know which applies to you.
Key Takeaways
- Medicare Part A, not Part B, covers hospice care, and there is no copay or coinsurance for hospice services.
- Your doctor must certify that you have a terminal illness with a life expectancy of six months or less for hospice to be covered.
- Hospice covers nursing care, medications for comfort, equipment, counseling, and respite care, but not curative treatments.
- If you are in a Medicare Advantage plan, contact your plan to find out whether it covers hospice through its network or through Original Medicare Part A.
- You can change your mind about hospice at any time and return to curative care without losing your Medicare coverage.
What Part A hospice coverage actually includes
Part A covers the full range of hospice services when a doctor certifies that you have a terminal condition and a life expectancy of six months or less. This includes skilled nursing visits, home health aide services, medications related to your terminal illness and comfort care, medical equipment and supplies (such as a hospital bed or oxygen), social work and counseling services, and spiritual care from a chaplain if you want it.
Part A also covers respite care — a short inpatient stay, usually up to five days, so that your family caregiver can rest. You pay a small copay for respite care (typically $5 per day, though this amount can change yearly), but the hospice agency arranges it and coordinates with the facility.
What Part A does not cover under hospice is any treatment meant to cure your illness. If you choose to pursue chemotherapy, radiation, or surgery, you would need to leave the hospice benefit and return to regular Medicare coverage for those treatments. Many people choose comfort care instead, but the choice is yours.
How the six-month prognosis requirement works
To receive hospice through Medicare Part A, your doctor must document that you have a terminal illness and are expected to live six months or less if the illness runs its natural course. This is not a hard important date — some people live longer than six months on hospice, and some live shorter. The six months is a medical judgment about what is likely, not a prediction that triggers automatic discharge.
If you are still alive after six months, your doctor can recertify you for another benefit period. This happens often, especially with conditions like heart disease or COPD that can be unpredictable. Each recertification extends your hospice coverage for another period, and you can stay on hospice as long as your doctor continues to certify that you meet the criteria.
The certification process requires two doctors to sign off: your attending physician and the hospice medical director. If you do not have an attending physician, the hospice medical director can serve as both. This dual-signature requirement is a Medicare rule designed to may support the decision is sound.
Part B's role in hospice-related care
While Part B does not cover hospice itself, it does cover certain doctor services that happen alongside hospice. If your primary care doctor or a specialist sees you for a condition unrelated to your terminal illness, Part B may cover that visit. For example, if you are on hospice for advanced cancer but develop a urinary tract infection, a doctor visit to diagnose and treat the infection could be covered by Part B.
In practice, most hospice patients do not seek Part B-covered services because the hospice team handles comfort care and symptom management. But the coverage exists if you need it. You would pay your Part B deductible and coinsurance as usual for those visits.
Part B also covers certain medications that are not related to your hospice condition. If you take a blood pressure medication or a statin for heart disease, and those are not part of your hospice plan of care, Part B may cover the prescription through your pharmacy benefit. Again, this is rare in practice because hospice typically manages all medications related to comfort.
What happens if you change your mind about hospice
You can leave hospice at any time and return to curative care without penalty or loss of coverage. If you decide you want to pursue treatment or if your condition improves and you no longer meet the six-month prognosis, you straightforward tell your hospice agency that you are discontinuing the service.
Once you leave hospice, your regular Medicare coverage resumes. Part A covers hospital and skilled nursing care, and Part B covers doctor visits and outpatient services as before. There is no waiting period, no reapplication, and no loss of benefits. You can also return to hospice later if your condition changes again.
This flexibility is important because some people choose hospice, then decide they want to try one more treatment, or their symptoms improve temporarily. Medicare does not penalize these changes. The hospice agency will discharge you from their service, and you will receive a summary of the care you received while enrolled.
Medicare Advantage plans and hospice coverage
If you are enrolled in a Medicare Advantage plan (Part C), your hospice coverage depends on your specific plan. Some Advantage plans have contracted with hospice agencies and cover hospice through their network, meaning you use a hospice provider that is part of the plan. Other plans automatically revert you to Original Medicare Part A for hospice, which means you can use any Medicare-certified hospice agency.
You must contact your Advantage plan directly to find out which applies to you. Call the customer service number on your plan card and ask: "Does my plan cover hospice through the plan network, or does it revert to Original Medicare Part A for hospice?" The answer will tell you whether you have a choice of hospice providers or whether you must use the plan's network.
If your plan reverts to Original Medicare for hospice, you will temporarily leave your Advantage plan for hospice services only. You will still be enrolled in the Advantage plan for other care, but hospice will be paid by Part A. When you leave hospice, you return to your Advantage plan for all coverage.
How to start the hospice process with Medicare
The process begins with your doctor. You or your family member should have a conversation with your doctor about whether hospice might be right for your situation. If your doctor agrees that you meet the criteria — a terminal illness with a life expectancy of six months or less — they will refer you to a hospice agency.
Your doctor does not need to submit paperwork to Medicare first. Instead, the hospice agency handles the Medicare paperwork once you are admitted. The hospice agency will obtain the required physician certifications, submit the claim to Medicare Part A, and coordinate your care. You will sign consent forms and a plan of care, and the agency will explain what is covered and what your out-of-pocket costs will be (usually just the respite care copay).
If you are in an Advantage plan, tell your doctor or the hospice agency which plan you are in so they can verify coverage before services begin. This prevents billing confusion later.
Frequently Asked Questions
Can I use Part B to pay for hospice if Part A is not available?
No. Part B does not cover hospice under any circumstance. Hospice is exclusively a Part A benefit. If you need hospice and do not have Part A coverage, you would need to enroll in Part A or work with a social worker to find alternative resources in your area.
What if my doctor thinks I need hospice but I am not sure?
You can ask your doctor to explain what hospice offers and what it means for your care. You can also ask to speak with a hospice agency's intake coordinator before making a decision. Choosing hospice does not mean you are giving up — it means you are shifting focus to comfort and quality of life. You can always change your mind later.
Does Medicare Part B cover the doctor who oversees my hospice care?
No. The hospice medical director and any doctors who work for the hospice agency are paid by the hospice benefit (Part A), not by Part B. Their services are included in the hospice coverage at no additional cost to you.
If I am on hospice, can I still see my regular doctor?
Yes, you can see your regular doctor if you choose, but most hospice patients do not because the hospice team provides all necessary care. If you do see your regular doctor for something unrelated to your hospice condition, Part B would cover that visit and you would pay your usual copay or coinsurance.
What if I live in a nursing home — does Part A still cover hospice?
Yes. Part A covers hospice whether you live at home, in a nursing home, or in an assisted living facility. The hospice agency will coordinate with the facility's staff to provide care. You still pay nothing for hospice services themselves, though you continue to pay for room and board at the facility.