Medicare pays for hospice care when a doctor says you have six months or less to live, and you choose comfort care instead of treatment aimed at cure
Hospice is a type of care focused on comfort and dignity when curative treatment is no longer the goal. Medicare Part A covers the full cost of hospice services — there is no copay, coinsurance, or deductible. You do not pay for the doctor visits, nursing, medications related to your terminal condition, equipment like hospital beds or wheelchairs, or counseling services that hospice provides.
The catch is that choosing hospice means you are also choosing to stop Medicare-covered treatments aimed at curing or treating your terminal illness. You can still see your regular doctor and receive treatment for other conditions. If you change your mind and want to pursue curative treatment again, you can leave hospice at any time, though you would then resume paying Medicare's normal costs for that treatment.
Key Takeaways
- Medicare Part A covers all hospice costs with no copay or deductible once a doctor certifies you have six months or less to live.
- You must choose hospice care instead of curative treatment, but you can leave hospice and resume treatment if you change your mind.
- Hospice can be provided at home, in a nursing home, hospital, or dedicated hospice facility, and Medicare covers all settings the same way.
- Two doctors must agree on the six-month prognosis before hospice begins, and Medicare reviews your case periodically to confirm you still meet the criteria.
- You are responsible for a small copay only if you need a prescription drug or respite care (temporary relief for your caregiver).
What Medicare covers under hospice
Medicare Part A pays for doctor visits, nursing care (including 24-hour on-call nursing), home health aide services, social work, chaplain services, and bereavement counseling for your family after you die. All medications related to your terminal condition are covered, as are medical equipment and supplies — oxygen, catheters, wound care supplies, and similar items.
If you need a hospital bed, wheelchair, walker, or other durable medical equipment, Medicare covers it through hospice. You also receive short-term inpatient respite care, which means Medicare will pay for a few days in a facility so your family caregiver can rest. Physical therapy, occupational therapy, and speech therapy are covered if they help with comfort rather than recovery.
The one cost you may face is a small copay — up to $5 per prescription for drugs and biologicals, and up to 5% of Medicare's approved amount for respite care. Most hospice organizations will waive these copays, but you should ask when you enroll.
How the six-month prognosis works
Before Medicare will pay for hospice, a doctor must certify that you have a terminal illness and are expected to live six months or less if the illness runs its natural course. This does not mean you will definitely die in six months — some people live longer, and that is fine. It means that based on your condition, six months is a reasonable medical estimate.
Two physicians must agree on this prognosis: your attending doctor (usually your primary care doctor) and the hospice medical director. If you do not have an attending doctor, the hospice medical director can be the only one. The hospice team will review your condition every 60 days to confirm you still meet the criteria. If you are living longer than expected and your condition has stabilized, Medicare may stop covering hospice — but this is uncommon, and the hospice team will discuss it with you if it happens.
Where you can receive hospice care
Hospice can be provided in your home, in a nursing home or assisted living facility, in a hospital, or in a dedicated hospice inpatient facility. Medicare covers the cost the same way regardless of setting. Most hospice care happens at home, with nurses and aides visiting regularly and being available by phone 24 hours a day.
If you are already in a nursing home or hospital when you enroll in hospice, the hospice team coordinates with that facility's staff. You do not have to move. Some people choose an inpatient hospice facility if they need more intensive symptom management or if their home situation does not allow for adequate care.
How to enroll in Medicare hospice
Your doctor will talk with you about hospice when they believe it is the right time. You can also ask your doctor about it if you think you are ready. Once you and your doctor agree, your doctor will refer you to a hospice organization. Medicare does not assign you to a specific hospice — you can choose which one, and there is no penalty for choosing a particular provider.
When you contact a hospice organization, they will send a nurse to assess you and explain what services they provide. You will sign consent forms stating that you understand you are choosing comfort care and that you are giving up Medicare coverage for curative treatment of your terminal condition. The hospice medical director will review your medical records and confirm the six-month prognosis. Once everything is in place, your hospice care begins.
You do not need to contact Medicare directly to enroll — the hospice organization handles the paperwork and billing. However, you should tell your Medicare Advantage plan (if you have one) that you are enrolling in hospice, because your coverage rules change while you are in hospice.
What happens if you leave hospice or change your mind
You can leave hospice at any time for any reason. If you want to resume curative treatment, you straightforward tell your hospice team and your doctor. Your Medicare coverage for curative care resumes, and you go back to paying your normal copays and deductibles for that treatment. Hospice coverage ends when ready.
Some people leave hospice because their condition improves or stabilizes. Others leave because they want to try a treatment they had not considered before. There is no penalty, and you can enroll in hospice again later if your condition worsens.
If you are in a Medicare Advantage plan, leaving hospice is more complex because your plan coverage changes. Talk to your plan before you leave hospice to understand how your coverage will work if you resume treatment.
Medicare Advantage and hospice
If you have a Medicare Advantage plan (Part C), you keep that coverage while you are in hospice, but only for services that are not related to your terminal condition. Your hospice care itself is paid by Original Medicare Part A, not by your Advantage plan. This means your Advantage plan's copays and deductibles do not explore to hospice services.
However, if you need treatment for a condition unrelated to your terminal illness — for example, you break your arm — your Advantage plan's normal rules explore to that care. Before you enroll in hospice, ask your Advantage plan to explain how your coverage will work, because the rules vary by plan.
Frequently Asked Questions
Can I still see my regular doctor while I am in hospice?
Yes. Your regular doctor can continue to see you for any condition, and they can coordinate with your hospice team. However, Medicare will not pay for curative treatment of your terminal illness while you are in hospice. If you want that treatment, you must leave hospice first.
What if I want hospice but my doctor does not think I am ready?
You can ask for a second opinion from another doctor, or you can contact a hospice organization directly and ask them to evaluate you. Hospice organizations can initiate the referral process themselves. If you and a hospice doctor both believe hospice is appropriate, that may be enough to move forward.
Does hospice mean I have to die at home?
No. Hospice can be provided anywhere — your home, a facility, or a hospital. Some people move to an inpatient hospice facility in their final days for better symptom management. You and your hospice team can discuss what setting works best for you.
Will Medicare pay for my family to take time off work?
No. Medicare does not pay wages or lost income for family caregivers. However, hospice does provide respite care — a few days in a facility so your caregiver can rest — and Medicare covers that at no cost to you (except a small copay that many hospices waive).
What if I outlive the six-month prognosis?
Medicare will continue to cover your hospice care. The six-month estimate is not a important date. Your hospice team reviews your condition periodically, and as long as you still have a terminal illness, Medicare pays for your care. If your condition improves significantly and you no longer meet hospice criteria, Medicare may stop coverage, but this is rare.