Medicare hospice benefits: who qualifies, what it covers and what you pay

Few decisions a family makes are harder than choosing hospice. It usually comes after a long illness, often after a conversation with a doctor that nobody wanted to have, and it arrives with a stack of forms at the worst possible time. Knowing in advance how the Medicare hospice benefit works will not make the decision easy, but it can take the guesswork out of the money, the paperwork and the rights you keep along the way.

This guide walks through the benefit from start to finish: who qualifies, what the hospice team provides, what Medicare pays and what it does not, what you pay, how long hospice can last, how to stop it or switch providers, and what to do if you disagree with a decision. It is based on the Centers for Medicare & Medicaid Services (CMS) booklet Medicare Hospice Benefits, March 2026 edition, with supporting detail from the Medicare & You 2027 handbook, the CMS Medicare Appeals booklet and the Medigap chart in Choosing a Medigap Policy.

What hospice is

CMS describes hospice as a program of care and support for people who are terminally ill and for their families. Terminally ill, for Medicare purposes, means a life expectancy of 6 months or less if the illness runs its normal course. The booklet goes out of its way to say that hospice is not only for people with cancer. Any terminal illness can qualify.

When you get hospice care, according to CMS:

• The focus is on comfort, called palliative care, rather than on curing the illness.
• Services typically include physical care, counseling, drugs, equipment and supplies for the terminal illness and related conditions.
• A specially trained team of professionals and caregivers looks after the whole person, including physical, emotional, social and spiritual needs.
• Care is generally given in the home.
• Family caregivers can get support too.

Palliative care is the heart of it

Palliative care is the part of hospice that helps people who are terminally ill, and their families, keep their quality of life. CMS says it can address physical, intellectual, emotional, social and spiritual needs, and that it supports your independence, your access to information and your ability to make choices about your own health care. In other words, choosing hospice is not giving up decision-making. You stay in charge of your care; the goal of that care changes from cure to comfort.

Who qualifies for the Medicare hospice benefit

Hospice is a Part A benefit. If you have Medicare Part A (Hospital Insurance) and meet all three of these conditions, you can get hospice care:

1. Your hospice doctor and your regular doctor, if you have one, certify that you are terminally ill, meaning you are expected to live 6 months or less.
2. You accept comfort care (palliative care) instead of care to cure your illness.
3. You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Two details in the booklet are worth underlining. First, only your hospice doctor and your regular doctor can certify that you are terminally ill. A salesperson, a marketer or anyone else cannot. Second, signing the hospice statement is not a one-way door. CMS says plainly that if you choose hospice, you have the right to change your mind, stop hospice and go back to treatment for your terminal illness. That right is covered in more detail below.

A free consultation before you decide

Before you start hospice, Medicare covers a one-time consultation with a hospice medical director or hospice doctor to talk about your care options and how to manage your pain and symptoms. You can have this consultation even if you end up deciding not to get hospice care. For a family still weighing the choice, it is a way to get answers from someone who does this work every day, without committing to anything.

Finding a hospice provider

Medicare only covers hospice care from a Medicare-approved hospice provider, so the first practical step is finding one. CMS suggests three ways:

• Talk to your doctor.
• Use the Care Compare tool at Medicare.gov/care-compare to find Medicare-approved hospice providers in your area and compare them on the quality of care they provide.
• Call your state hospice organization. To get its number, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

If you belong to a Medicare Advantage Plan and want to start hospice, your plan must help you find a Medicare-approved hospice provider in your area, and the booklet says your plan must give you a list of approved hospice providers in your service area.

How the hospice benefit works day to day

Once you qualify, you and your family work with the hospice provider to set up a plan of care that fits your needs. You and your family are part of the team. According to CMS, the rest of the team may include:

• Doctors
• Nurses or nurse practitioners
• Counselors
• Social workers
• Pharmacists
• Physical and occupational therapists
• Speech-language pathologists
• Hospice aides
• Homemakers
• Volunteers

A hospice nurse and doctor are on call 24 hours a day, 7 days a week, to give you and your family support and care when you need it. For families caring for someone at home, that around-the-clock line is often what makes home care possible.

A hospice doctor is part of your medical team, but you do not have to give up the doctor you know. You can choose to include your regular doctor, a nurse practitioner or a physician assistant on your team as the attending medical professional.

Where you get hospice care

Hospice is built around letting you and your family stay together at home. The Medicare & You 2027 handbook adds that you can usually get Medicare-certified hospice care in your home or in another facility where you live, such as an assisted living facility or a nursing home.

If your hospice provider decides you need inpatient care, it makes the arrangements for your stay. Covered inpatient settings include a hospice inpatient facility, a Medicare-participating hospital or a skilled nursing facility. The handbook specifies that the facility must be Medicare-approved and must contract with the hospice provider.

What Medicare covers in hospice

Once your hospice benefit starts, Original Medicare covers everything you need related to your terminal illness and related conditions, as long as the care comes from a Medicare-approved hospice provider. Depending on your illness, the plan of care your hospice team writes can include any or all of these services:

• Doctor services
• Nursing care
• Medical equipment, like wheelchairs or walkers
• Medical supplies, like bandages and catheters
• Prescription drugs for pain and symptom control
• Hospice aide and homemaker services
• Physical and occupational therapy
• Speech-language pathology services
• Social worker services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care for pain and symptom management
• Short-term respite care
• Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

Notice that grief and loss counseling covers the family, not only the patient. Hospice is one of the few places in Medicare where the people around the beneficiary are part of what the benefit is meant to support.

Respite care: a break for the caregiver

Caring for someone at the end of life is exhausting. If your usual caregiver, such as a family member, needs rest, you can get inpatient respite care in a Medicare-approved facility such as a hospice inpatient facility, a hospital or a nursing home. Your hospice provider arranges it. You can stay up to 5 days each time you get respite care. You can use respite care more than once, but CMS says only on an occasional basis. There is a small cost for respite, covered in the costs section below.

What the hospice benefit will not cover

Choosing hospice means you have decided you no longer want care to cure your terminal illness, or your doctor has determined that efforts to cure it are not working. With that in mind, once your hospice benefit starts it will not cover:

• Treatment intended to cure your terminal illness or related conditions. If you are thinking about curative treatment, talk with your doctor. You always have the right to stop hospice at any time.
• Prescription drugs that are not for your terminal illness or related conditions. These are not part of the hospice benefit, but they may be covered by your Medicare drug coverage (Part D), where you may have a copayment.
• Care from any provider that the hospice team did not set up. The hospice team must give or arrange all care for your terminal illness and related conditions. You cannot get the same type of hospice care from a different hospice unless you change hospice providers. You can still see your regular doctor, nurse practitioner or physician assistant if you chose them as your attending medical professional.
• Room and board. Hospice does not pay rent at a nursing home or assisted living facility where you live. If the hospice team decides you need short-term inpatient or respite care that it arranges, Medicare covers that stay in the facility.
• Hospital outpatient care (such as an emergency room visit), hospital inpatient care or ambulance transportation that is unrelated to your terminal illness, unless your hospice team arranges it.

CMS's advice on that last point is direct: contact your hospice team before you get any of these services, or you might have to pay the full cost. That is one of the most important practical lessons in the booklet, and it is why the hospice team's 24-hour on-call nurse and doctor matter so much: they are the people to reach before any hospital, emergency room or ambulance service that the team has not arranged.

The room-and-board exclusion surprises many families. Medicare's hospice benefit pays for the care, not the residence. Someone who lives in a nursing home or assisted living facility can get hospice care there, but the hospice benefit does not pay that facility's room and board. Medicare's separate rules for skilled nursing facility stays are explained in our guide to Medicare and skilled nursing care, and long-term custodial care is covered in what Medicare doesn't cover.

Care for other health problems while you are in hospice

Hospice covers your terminal illness and related conditions. It does not mean every other health problem goes untreated. After your hospice benefit starts, Original Medicare still pays for covered services for health problems that are not part of your terminal illness and related conditions. For those services, you pay the normal deductible and coinsurance amounts, the same as any other Medicare patient.

That raises an obvious question: who decides what is related to the terminal illness? The booklet gives you a tool. You can ask your hospice provider for a list of the items, services and drugs it has determined are not related to your terminal illness and related conditions. The list must explain why each one is not related. Your hospice provider must also give the list to your non-hospice providers or to Medicare if they ask for it. If a medication or service you have relied on stops being covered by hospice, this list is where to start.

What you pay for hospice care

Medicare pays the hospice provider directly for your hospice care, and there is no deductible. Here is what CMS says you pay:

CMS gives an example for respite: if Medicare approves $100 a day for inpatient respite care, you pay $5 a day and Medicare pays $95 a day. The booklet notes that the amount you pay for respite can change each year. Many people have premium-free Part A; if you buy Part A, our Part A costs page has the current amounts, and the Part B premium page has the standard Part B premium.

In the rare case that the hospice benefit does not cover a drug you need, your hospice provider should contact your Medicare drug plan, if you have one, to find out whether the plan covers it.

The hospital trap

If you need inpatient hospital care for your terminal illness or related conditions, your hospice provider must make the arrangements. When it does, the hospice benefit covers your inpatient hospice care in the hospital and pays the hospice provider, and the hospice and the hospital work out the payment between them under their contract. But CMS warns that if you go to the hospital and your hospice provider did not make the arrangements, you might be responsible for the entire cost of your hospital care. It is the same lesson as above, with higher stakes: call the hospice first.

If the hospice refuses something your doctor ordered

If you pay out of pocket for an item or service your doctor ordered but your hospice provider refused to give it to you, you can file an appeal with Medicare. Your State Health Insurance Assistance Program (SHIP) can help you file or understand the appeal. For more on claims and appeals, CMS points to Medicare.gov/claims-appeals and 1-800-MEDICARE, and our guide to Medicare appeals walks through each level.

How Medigap helps with hospice costs

If you have a Medicare Supplement Insurance (Medigap) policy, the hospice booklet says it covers your hospice costs for drugs and respite care, and it also helps with costs for health problems that are not part of your terminal illness. The Medigap chart in Choosing a Medigap Policy shows how much of the Part A hospice coinsurance or copayment each standardized plan pays:

In Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized differently, and hospice cost sharing is one of the basic benefits in all three states. For questions about your own policy, CMS suggests calling your Medigap insurer or your SHIP; you can find your SHIP at shiphelp.org or through 1-800-MEDICARE. Our guide to Medigap plans explains every plan letter.

Hospice if you are in a Medicare Advantage Plan

This is one of the most confusing parts of the benefit, and the rule is simpler than people expect. Once you start hospice, Original Medicare covers everything you need related to your terminal illness, even if you stay in a Medicare Advantage Plan. The Medicare & You 2027 handbook says Original Medicare is billed for your hospice care, and that you are not required to switch back to Original Medicare for it to cover hospice.

If you were in a Medicare Advantage Plan before starting hospice, you can stay in it as long as you keep paying the plan's premiums. If you stay, your plan covers:

• Any extra services that are medically necessary, like dental and vision benefits.
• Covered services for health problems that are not related to your terminal illness. You can get these from Original Medicare or from your plan. From Original Medicare you may pay a copayment; from your plan (for example, a network provider in an HMO) you pay only the plan's copayment. If you paid a copayment under Original Medicare, keep your receipts. The booklet says your plan must reimburse you for the extra amount you paid.
• Drugs not related to your terminal illness, if your plan includes drug coverage.

If your plan does not cover out-of-network providers, Original Medicare covers services that are not related to your terminal illness.

How long hospice care can last

The 6-month life expectancy is a standard for qualifying, not a deadline. If you live longer than 6 months, you can keep getting hospice care as long as the hospice medical director or another hospice doctor recertifies that you are terminally ill.

Hospice care is given in benefit periods:

• Two 90-day benefit periods, followed by
• An unlimited number of 60-day benefit periods.

A benefit period starts the day you begin hospice care and ends when that 90-day or 60-day period ends. At the start of the first 90-day period, both your hospice doctor and your regular doctor, if you have one, must certify that you are terminally ill. At the start of each later period, the hospice medical director or another hospice doctor must recertify it so your care can continue. You do not have to re-choose hospice for each new benefit period; once your benefit starts, it continues as long as you are recertified.

Hospice benefit periods are not the same as the Part A benefit periods that apply to hospital and skilled nursing facility stays. They follow their own schedule of 90-day and 60-day periods.

Changing hospice providers

You have the right to change your hospice provider once during each benefit period. If the care you are getting is not what you expected, you are not locked in for the rest of your life.

Stopping hospice care

Some people improve. An illness can go into remission, or a patient may simply decide to pursue treatment again. CMS says you always have the right to stop hospice care at any time. If you choose to stop, your hospice provider will ask you to sign a form that includes the date your care will end.

The booklet adds an important protection: no one should ask you to sign forms about stopping hospice if you did not ask for them. Stopping hospice is a choice only you can make, and you should not sign or date any forms until the actual date you want hospice to stop.

What happens next depends on where you started:

• If you were in Original Medicare when you stopped, you continue in Original Medicare. If you are eligible, you can go back to hospice at any time.
• If you were in a Medicare Advantage Plan when you started hospice and kept paying the plan's premiums, you can continue to get Medicare coverage from your plan after you stop hospice.

If the hospice says you no longer qualify

Stopping by choice is different from being told that you no longer qualify. If your hospice provider or doctor believes you are no longer eligible because your condition has improved and you disagree, you have the right to ask for a review of your case. The hospice booklet says your provider should give you a notice explaining your right to an expedited (fast) review by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). If you do not get the notice, ask for it. It lists your BFCC-QIO's contact information and explains your rights.

The CMS Medicare Appeals booklet lists hospices among the providers whose services you can appeal on a fast track, and it sets out the steps:

1. The notice. You should get a notice called the Notice of Medicare Non-Coverage at least 2 days before covered services end. It includes the date your covered services end, your right to appeal, how to contact the BFCC-QIO in your state, and when you will or will not have to pay for services after the end date.
2. The deadline. Follow the instructions on the notice no later than noon the day before the termination date listed on it.
3. The explanation. The BFCC-QIO notifies the provider, and by the end of that day the provider must give you a Detailed Explanation of Non-Coverage, including why your services are no longer covered and the coverage rule that applies.
4. The decision. The BFCC-QIO asks why you believe coverage should continue, looks at your medical records and decides by close of business the day after it gets the information it needs.

If the BFCC-QIO decides your services are ending too soon, Medicare may continue to cover your hospice services, depending on your care needs, except for any applicable coinsurance or deductibles. If it decides your services should end, you are not responsible for hospice services provided before the coverage end date on the notice, but you may have to pay for services after that date. The BFCC-QIO is administered for Medicare by Livanta or Acentra depending on your state, and the booklet asks you to check their websites to make sure you contact the right one.

Your rights and how to complain about care

As a person with Medicare, you have guaranteed rights. The hospice booklet highlights the right to care that meets professionally recognized standards. If you believe your care falls below that standard and you are not satisfied with how your hospice provider responded to your concern, you can contact your BFCC-QIO. The full list of Medicare rights is at Medicare.gov/basics/your-medicare-rights, or you can call 1-800-MEDICARE.

To complain about the quality of care in a health care facility, CMS lists two routes:

• File a complaint with your state's survey agency. CMS publishes the agencies' addresses and phone numbers on CMS.gov under health safety standards and quality and safety oversight contact information.
• If you are uncomfortable complaining to your hospice provider, or not satisfied with how it handled your complaint, file one with your BFCC-QIO through Livanta or Acentra, or by calling 1-800-MEDICARE.

Protect yourself from hospice fraud

CMS warns that Medicare fraud can happen anywhere, and the hospice booklet singles out hospice scams. Some scammers try to sign people up for hospice even when they do not need it, offering services the hospice team does not actually provide. Being enrolled in hospice when you are not terminally ill is not harmless: as explained above, the hospice benefit does not cover treatment to cure an illness. The booklet's tips:

• Your doctor is the only one who can certify that you are terminally ill, with a life expectancy of 6 months or less. If you are not terminally ill, you should not get hospice care.
• Never accept perks or gifts for signing up for hospice services.
• Medicare will not provide "free" services like housekeeping.
• Do not share your Medicare Number if someone offers you free services like housekeeping or cooking.

To learn how to spot and report fraud, visit Medicare.gov/fraud. To report possible fraud, call 1-800-MEDICARE (1-800-633-4227); TTY users can call 1-877-486-2048. The Medicare & You 2027 handbook also asks everyone to check their Medicare Summary Notices, receipts and statements for errors or services they did not get.

A checklist for families

Every item below comes from a right or a rule in the CMS booklets cited above:

• Use the free one-time consultation with a hospice doctor before deciding, even if you are not sure.
• Confirm the hospice provider is Medicare-approved; compare providers on Medicare.gov/care-compare.
• Decide whether your regular doctor, a nurse practitioner or a physician assistant will be the attending medical professional.
• Save the hospice's 24/7 on-call number and call it before going to the hospital or an emergency room.
• Ask for the hospice's list of items, services and drugs it considers unrelated to the terminal illness.
• Check how your Medigap policy or Medicare Advantage Plan handles costs that hospice does not cover, and keep copayment receipts.
• If a caregiver needs a break, ask the hospice to arrange respite care, up to 5 days at a time.
• Remember you can change hospice providers once per benefit period and stop hospice at any time.
• Never sign a form ending hospice unless you asked to stop, and never date it before the day you want care to end.
• If you are told you no longer qualify and you disagree, ask for the notice and request a fast review by noon the day before services end.

Where to get help

For Medicare questions, call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, or visit Medicare.gov/coverage/hospice-care. Your SHIP offers free, one-on-one counseling on Medicare choices and appeals. The hospice booklet is available in Spanish at es.Medicare.gov. CMS also lists three private organizations for more information about hospice: the National Alliance for Care at Home, the Family Caregiver Alliance and the Hospice Foundation of America.

Hospice exists so that the last months of a life can be spent with as much comfort and dignity as possible, and so that the people doing the caregiving are not left to do it alone. Knowing the rules ahead of time means the time can be spent on what matters, rather than on paperwork.