Medicare covers hospice care when a doctor certifies you have six months or less to live, and you choose comfort care over curative treatment

Medicare Part A pays for hospice services once your doctor and a hospice medical director both agree that your condition is terminal. You do not pay a monthly premium for hospice the way you do for other Medicare services. Instead, Medicare covers the full cost of hospice care — doctor visits, nursing, medications related to your terminal condition, equipment, and counseling — with no deductible and no copayment for most services.

The catch is that choosing hospice means you are also choosing to stop pursuing curative treatment through Medicare. If you later decide you want to resume treatment aimed at curing or controlling your illness, you can leave hospice, but you cannot be on both at the same time. Hospice is available through Medicare Part A whether you have Original Medicare or a Medicare Advantage plan, though the details of coverage vary slightly between the two.

Key Takeaways

  • Medicare Part A covers the full cost of hospice care with no deductible or copayment once a doctor certifies a terminal diagnosis with six months or less to live.
  • You must choose hospice instead of curative treatment, not in addition to it, and you can change your mind and resume treatment at any time.
  • Medicare covers hospice nursing, doctor visits, medications for your terminal condition, medical equipment, and grief counseling for your family after you die.
  • You select a Medicare-certified hospice provider, and that provider bills Medicare directly — you do not submit claims yourself.
  • If you have a Medicare Advantage plan, your hospice coverage works the same way, but you should contact your plan before enrolling to confirm your specific coverage.

What Medicare Hospice Coverage Includes

Medicare Part A covers the following services under hospice: nursing care provided by a registered nurse or licensed practical nurse, doctor visits from your hospice physician or your own doctor, home health aide services for personal care, social work and counseling, medications prescribed for your terminal illness and its symptoms, medical equipment such as a hospital bed or oxygen, and short-term inpatient care if you need it for pain management or symptom control that cannot be handled at home.

Medicare also covers grief counseling for your family members for up to 13 months after your death. Hospice providers employ or contract with chaplains, social workers, and counselors who can meet with your family before and after you pass. This is included in your hospice coverage at no cost to you or your family.

What Medicare does not cover under hospice: treatments aimed at curing your illness, such as chemotherapy or radiation; hospitalization for treatment unrelated to your terminal condition; or prescription drugs not related to managing your terminal illness or its symptoms. If you need treatment for a separate, non-terminal condition — say, a broken arm — Medicare may cover that through a different benefit, but you would need to discuss this with your hospice provider and your doctor.

How the Six-Month Prognosis Works

The "six months or less to live" standard is a medical judgment, not a hard important date. Your doctor and the hospice medical director must both certify that your condition would likely result in death within six months if the disease runs its natural course. This is based on the trajectory of your illness, not on a specific test result or calendar date.

If you live longer than six months, you can stay on hospice as long as your condition continues to meet the criteria. Medicare will recertify your may be able to access every 60 days for the first two recertifications, then every 30 days after that. If at any point your condition improves or stabilizes enough that the six-month prognosis no longer applies, you would be discharged from hospice. You can also request to leave hospice yourself at any time, for any reason.

Original Medicare Versus Medicare Advantage Hospice Coverage

If you have Original Medicare (Part A and Part B), hospice coverage is straightforward: Part A pays for all hospice services with no deductible or copayment. You choose a Medicare-certified hospice provider in your area, and that provider handles all billing with Medicare.

If you have a Medicare Advantage plan, your hospice coverage is the same in terms of what is paid for, but your plan may have additional requirements or restrictions. Some Medicare Advantage plans require you to use a hospice provider within their network, while others cover any Medicare-certified provider. Before you enroll in hospice, contact your Medicare Advantage plan to confirm whether your chosen provider is in-network and whether there are any steps you need to take with your plan.

In either case, you do not pay out of pocket for hospice services covered by Medicare. If your hospice provider bills you for a covered service, contact Medicare or your plan to report it.

How to Enroll in Medicare Hospice

Enrollment in hospice begins with a conversation between you, your doctor, and a hospice provider. Your doctor does not have to work for the hospice — you can use your own doctor — but the hospice medical director must also sign off on the terminal diagnosis. Once both doctors agree, the hospice provider will walk you through the enrollment process, which involves signing a consent form stating that you understand you are choosing comfort care over curative treatment.

You can find Medicare-certified hospice providers in your area by visiting Medicare.gov and using the Care Compare tool, or by calling 1-800-MEDICARE. When you contact a hospice, they will ask about your diagnosis, your current medications, and your living situation, so they can determine whether they can serve you and what level of care you need.

Hospice can be provided in your home, in a nursing home, in an assisted living facility, or in a hospice inpatient facility, depending on your needs and what is available in your area. Most hospice care happens at home, with nurses and aides visiting on a schedule you agree to.

What Happens If You Change Your Mind

You can leave hospice at any time and resume curative treatment. If you do, Medicare will stop paying for hospice services, and your regular Medicare benefits resume. There is no penalty for changing your mind, and you can re-enroll in hospice later if your condition changes again.

Some people leave hospice because their condition improves or stabilizes. Others leave because they want to try a treatment they had not considered before. Still others leave because they want a second opinion on their diagnosis. All of these are valid reasons, and your hospice provider is required to help you transition back to regular care.

If you are on a Medicare Advantage plan and you leave hospice, contact your plan to confirm that your regular benefits resume and that you are no longer enrolled in their hospice benefit.

Common Mistakes to Avoid

Do not wait until you are in crisis to talk to your doctor about hospice. The best time to discuss it is when your doctor first mentions that curative treatment is no longer working or is no longer an option. This gives you time to ask questions, learn about providers in your area, and make a decision without pressure.

Do not assume that choosing hospice means you are giving up. Hospice is a different kind of care, focused on comfort and quality of life rather than cure. Many people find that hospice allows them to spend more time with family and experience less pain than they would have otherwise.

Do not forget to tell your family members, your lawyer, and anyone else who needs to know that you have enrolled in hospice. Make sure your advance directive or living will is up to date and that your healthcare proxy knows your wishes. Hospice providers can help coordinate this, but it is your responsibility to communicate with the people in your life.

Frequently Asked Questions

Does Medicare cover hospice for children?

Yes. Medicare covers hospice for beneficiaries of any age who meet the terminal diagnosis requirement. The process is the same: a doctor and hospice medical director must certify a six-month prognosis, and the family chooses comfort care over curative treatment. Pediatric hospice providers specialize in working with children and families.

What if my hospice provider is not Medicare-certified?

Medicare will not pay. You must use a provider that is certified by Medicare. You can verify a provider's certification on Medicare.gov or by calling 1-800-MEDICARE. If you are already working with a non-certified provider, ask them whether they are in the process of becoming certified, or whether they can refer you to a certified provider in your area.

Do I have to use hospice if my doctor says I am terminal?

No. Hospice is always your choice. Your doctor can recommend it, but you decide whether to enroll. If you want to continue pursuing curative treatment even after your doctor says it is unlikely to work, that is your right. However, Medicare will not pay for hospice services unless you have made the choice to focus on comfort care.

Can I use hospice and still see my regular doctor?

Yes. You can continue to see your own doctor while on hospice. Your doctor and the hospice medical director will coordinate your care. Some people prefer to keep their longtime doctor involved, and hospice providers expect and support this.

What if I live in a nursing home — does Medicare still cover hospice?

Yes. Medicare covers hospice for people living in nursing homes, assisted living facilities, or any other setting. The hospice provider will coordinate with the facility's staff to deliver care. You do not pay the nursing home separately for hospice services — Medicare pays the hospice provider directly.