A Guide To Medicare Hospice Coverage: Eligibility, Costs, Benefits

Hospice care focuses on comfort and quality of life for people with a terminal illness.

If you or a loved one is considering hospice, understanding how Medicare hospice coverage works—eligibility, enrollment, what’s covered, and costs—can help you plan with confidence.

Is Hospice Covered by Medicare?

Yes. Medicare coverage for hospice is provided under Part A when specific requirements are met. Most Americans 65+ qualify for Part A, and some people under 65 with a qualifying disability also have Part A. For the official rules and a quick overview, see Medicare’s page on hospice coverage.

When you elect hospice, Medicare shifts its focus from curing your terminal illness to managing symptoms and maximizing comfort. You can still get Medicare-covered care for conditions unrelated to your terminal diagnosis. Hospice services are delivered by a Medicare-certified hospice and typically happen at home or wherever you live (including an assisted living or nursing facility), with short-term inpatient care available if symptoms become difficult to manage at home.

Who’s Eligible for Medicare Hospice?

To receive hospice through Medicare, you must meet all of the following:

Have Medicare Part A.
Be diagnosed with a terminal illness with a life expectancy of six months or less if the disease runs its normal course.
Get certification from two clinicians: your hospice medical director and your attending physician (often your primary or specialist).
Choose palliative care over curative treatment for your terminal condition. You can still treat health issues unrelated to the terminal illness.
Use a Medicare-certified hospice.

Coverage is divided into benefit periods: two 90-day periods followed by an unlimited number of 60-day periods. Before each new period after day 180, a hospice clinician completes a face-to-face assessment and recertifies that you remain eligible. Many people receive hospice longer than six months because they continue to qualify during recertifications.

Enrollment: How to Start Hospice

Talk with your doctor about prognosis and goals of care, then contact a Medicare-certified hospice.
Compare providers using Medicare’s Care Compare to review services, quality measures, and locations.
Sign the hospice election form with your chosen hospice. You’ll name an attending physician (if you want one) and agree to palliative, not curative, treatment for the terminal diagnosis.
Get a plan of care tailored by an interdisciplinary team (physician, nurse, social worker, chaplain, aide, volunteers). The plan adjusts as your needs change.

If you need free, unbiased help, contact your State Health Insurance Assistance Program (SHIP): shiphelp.org.

What Medicare Hospice Covers

Hospice is an all-inclusive benefit for care related to your terminal diagnosis and related conditions. Key covered services include:

Interdisciplinary team care: regular nursing visits; physician oversight; social work; spiritual counseling; hospice aides for personal care; trained volunteers.
Medications for symptom control and pain relief related to the terminal illness.
Durable medical equipment and supplies (e.g., hospital bed, oxygen, walker, commode, wound supplies) delivered to your home.
Short-term inpatient care for symptom management that can’t be managed at home.
Continuous home care (brief, intensive nursing) during crises to control acute symptoms at home.
Inpatient respite care to give caregivers a break for up to five consecutive days at a time.
Grief and bereavement support for family/caregivers for at least 12 months after death.

Note: Hospice does not normally pay for room and board if you live in a nursing home or assisted living facility. Those costs may be covered by Medicaid, long-term care insurance, or private pay. Hospice also doesn’t cover treatments aimed at curing the terminal illness (like chemotherapy) once you elect hospice; however, it will cover treatments needed to relieve symptoms of that illness.

What It Costs Under Medicare

Medicare hospice coverage is designed to keep your out-of-pocket costs low:

$0 for hospice services related to your terminal condition (nursing, social work, equipment, supplies, etc.).
Prescription drugs for symptom control and pain: you may pay up to $5 per prescription (usually minimal).
Inpatient respite care: you owe 5% coinsurance of the Medicare-approved amount.
Room and board at a facility (nursing home/assisted living) are not covered by hospice.
Ambulance/ER may be covered if arranged by the hospice and related to your terminal condition; otherwise, standard Medicare rules apply.

You’ll still pay any regular Medicare premiums (like Part B or a Medicare Advantage plan) and cost-sharing for care unrelated to your terminal illness. For a quick refresher on general costs, visit Medicare costs.

Medicare Advantage, Medigap, and Other Coverage

If you’re enrolled in a Medicare Advantage (MA) plan, hospice is generally paid by Original Medicare, even while you stay in your MA plan. Your MA plan may still cover supplemental benefits and unrelated care. Some MA plans participate in special demonstrations that integrate hospice benefits—coverage details can vary, so review your plan’s Evidence of Coverage and ask how hospice works with your plan.

Medigap (Medicare Supplement) may help with cost-sharing for care unrelated to hospice that Original Medicare covers. Medicaid can coordinate with Medicare hospice and may cover room and board in a nursing facility for eligible beneficiaries. If you have employer or retiree coverage, ask how it coordinates with Medicare hospice to avoid duplicate copays.

Your Rights and Flexibility

Change hospice providers: You can transfer once per benefit period (and more with good cause) if another certified hospice is a better fit.
Revoke hospice at any time: If you decide to pursue curative treatment again, you can revoke hospice and return later when appropriate.
Discharge if you improve: If your condition stabilizes or improves, you may be discharged and re-enroll later if eligibility returns.
Choose your attending physician (or none) to work with the hospice team.
No DNR required: You do not need a do-not-resuscitate order to elect hospice (policies may vary by provider; discuss your preferences).
Appeal rights: You can appeal coverage decisions or a discharge you believe is premature.

Practical Tips to Avoid Surprises

Clarify “related vs. unrelated” conditions: Ask the hospice which medications, supplies, and treatments it deems related to your terminal illness (and therefore covered).
Review the hospice formulary: If a medication isn’t on it, ask about alternatives or exceptions before you fill at the pharmacy.
Confirm equipment and supplies: Discuss what will be delivered to your home and who to call for repairs or refills. Learn more about what counts as durable medical equipment.
Plan for nights and weekends: Know your hospice’s 24/7 on-call process and expected response times during symptom crises.
Ask about inpatient partners: If symptoms worsen, which hospitals or inpatient units does the hospice use for short-term care?
Use advance care planning: Medicare covers voluntary conversations with your clinician about goals and preferences; see advance care planning.
Compare options early: Interview two or three hospices to understand services, cultural or spiritual supports, respite availability, and caregiver training.

FAQs

Can I keep getting treatment for conditions not related to my terminal illness?

Yes. You can continue to receive Medicare-covered care for unrelated conditions (e.g., diabetes management) under normal Medicare rules. Your hospice covers care and medications related to your terminal diagnosis and related conditions.

Where can I receive hospice care?

Most people receive hospice at home. You can also receive hospice in an assisted living facility or nursing home (room and board generally not covered by Medicare), or in a hospice inpatient unit for short-term symptom management or respite.

What if I change my mind?

You can revoke hospice at any time and resume standard Medicare coverage for curative treatments. If you later decide hospice is appropriate again, you can re-elect it as long as you meet eligibility criteria.