Yes, Medicare covers hospice care under Part A at little to no cost when a doctor certifies that a patient has a terminal illness with a life expectancy of six months or less. The patient must also agree to stop curative treatment for the terminal condition and sign an election statement choosing comfort-focused care instead.
Under 42 CFR §418.3, Medicare requires both the patient’s attending physician and a hospice medical director to certify terminal illness before benefits begin. Failure to meet this dual-certification requirement is the single largest reason for hospice claim denials — accounting for 55% of all hospice denials in recent Medicare audits.
In 2022, 1.72 million Medicare beneficiaries enrolled in hospice for at least one day, and nearly half of all Medicare deaths occurred while the patient was receiving hospice services. By Q4 2024, hospice utilization topped 50% for the first time since before the pandemic.
Here’s what you’ll learn in this article:
- 🏥 Exactly what Medicare’s hospice benefit covers — and what it doesn’t — so you avoid surprise bills
- ⏰ How hospice benefit periods work, including the 90-90-60 day structure and unlimited recertification rules
- 💡 Three real-world scenarios showing how families use hospice coverage (with action-consequence tables)
- ⚠️ The most common mistakes that cause Medicare to deny hospice claims and how to prevent them
- 💰 How Medicare Advantage, Medicaid, and private insurance interact with the hospice benefit across different states
What the Medicare Hospice Benefit Actually Covers
Medicare Part A pays for all medically necessary services related to the terminal illness and related conditions. Medicare-certified hospice providers must deliver a full range of comfort care once a patient elects the benefit.
Covered services include doctor visits, nursing care, prescription drugs for pain and symptom control, medical equipment like wheelchairs and hospital beds, medical supplies such as bandages and catheters, hospice aide and homemaker services, physical therapy, occupational therapy, speech therapy, social worker services, dietary counseling, and grief and loss counseling for both the patient and family. Short-term inpatient care for pain and symptom management and short-term respite care are also fully covered.
The cost to the patient is remarkably low. Patients pay $0 for most hospice services from a Medicare-certified provider. There are only two exceptions: a copay of up to $5 per prescription for outpatient drugs related to pain and symptom control, and 5% coinsurance for inpatient respite care.
What Medicare Won’t Cover Under Hospice
Understanding what falls outside the benefit prevents unexpected costs. Medicare does not pay for room and board if you receive hospice at home, in a nursing home, or in an inpatient facility. It also won’t cover curative treatments aimed at curing the terminal illness once you’ve elected hospice.
Emergency room visits and ambulance transport unrelated to the terminal illness are only covered if your hospice team arranges them. If you go to the ER without contacting your hospice team first, you could be responsible for the full cost. Care for conditions unrelated to your terminal diagnosis is still billed to your regular Medicare benefits with standard cost-sharing.
The Four Levels of Hospice Care Medicare Requires
Every Medicare-certified hospice provider must offer four distinct levels of care. Your care level can change as your needs evolve, and you can move between levels at any time.
Routine Home Care
This is the most common level of hospice care, accounting for nearly 97% of all hospice days. The hospice team visits the patient wherever they live — at home, in an assisted living facility, or in a nursing home. Visits include nursing care, aide services, and other support according to the care plan.
Continuous Home Care (Crisis Care)
When a patient experiences a medical crisis — such as uncontrolled pain, severe breathing difficulty, or intense nausea — the hospice provides continuous nursing care at home for a minimum of eight hours in a 24-hour period. The goal is to manage acute symptoms so the patient can remain at home rather than being admitted to a facility. This level requires that more than half of the care during that period be provided by a registered nurse or licensed practical nurse.
General Inpatient Care
When symptoms become so severe that they cannot be managed at home, the patient may be admitted to a Medicare-approved inpatient facility — a hospital, hospice inpatient unit, or skilled nursing facility. General inpatient care is short-term and focused on getting symptoms under control so the patient can return to routine home care.
Respite Care
Respite care gives primary caregivers a break. Medicare covers up to five consecutive days at a time in a Medicare-approved facility. You can use respite care more than once, but only on an occasional basis. The patient pays 5% coinsurance of the Medicare-approved amount for each respite day.
How Hospice Benefit Periods Work: The 90-90-60 Structure
Medicare doesn’t limit hospice care to six months. The benefit is structured in specific periods that allow care to continue as long as a patient remains eligible.
The structure works like this: two 90-day benefit periods come first, followed by an unlimited number of 60-day periods. These must be used in order — 90, then 90, then 60, 60, 60, and so on. At the start of each new benefit period, a hospice doctor must recertify that the patient still has a life expectancy of six months or less.
Starting with the third benefit period (the first 60-day period), recertification requires a face-to-face encounter between the patient and a hospice physician or nurse practitioner. This face-to-face visit must document clinical findings that support a prognosis of six months or less. Missing this step causes the claim to be denied.
| Benefit Period | What Happens |
|---|---|
| First 90 days | Initial certification by attending physician and hospice medical director; patient elects hospice |
| Second 90 days | Recertification required; hospice doctor confirms continued terminal prognosis |
| Third period (60 days) | Face-to-face encounter required; recertification must include documented clinical findings |
| Every subsequent 60-day period | Same face-to-face and recertification requirements; no limit on how many periods a patient can use |
If a patient revokes or is discharged from hospice during a benefit period, the remaining days in that period are lost. They cannot be recovered. Once the two 90-day periods have been used, they are not renewable — the patient only has 60-day periods going forward.
Revoking and Re-Electing the Hospice Benefit
A patient or their representative can revoke hospice care at any time — but only in writing. A verbal revocation is not acceptable under Medicare rules. The written revocation must include a signed statement and the effective date.
When someone revokes, they give up all remaining hospice coverage for that benefit period and return to regular Medicare coverage. This means curative treatments are covered again under standard Part A and Part B rules. The patient can re-elect hospice later if they still meet the eligibility requirements, and a new benefit period will begin.
A hospice cannot revoke a patient’s election. The hospice can discharge a patient if they are no longer terminally ill, if the patient moves out of the service area, or in rare cases involving safety concerns for staff or the patient. Of the 1.6 million Medicare recipients served by hospices each year, approximately 17.4% are discharged alive.
Three Real-World Scenarios of Medicare Hospice in Action
Scenario 1: Margaret’s Cancer Diagnosis and Home Hospice
Margaret, age 74, has stage IV lung cancer. Her oncologist and hospice medical director both certify that her life expectancy is six months or less. Margaret signs the election statement, choosing comfort care over chemotherapy.
| Margaret’s Choice | What Medicare Covers |
|---|---|
| Elects hospice and stops chemotherapy | $0 for nursing visits, pain medication, hospital bed, and oxygen equipment |
| Needs stronger pain medication at home | Up to $5 copay per prescription for symptom-related drugs |
| Caregiver daughter needs a break after 3 months | Up to 5 days of respite care; Margaret pays 5% coinsurance per day |
| Develops unrelated urinary tract infection | Regular Medicare Part B covers the UTI treatment with standard cost-sharing |
Margaret lives for eight months. Her hospice doctor recertifies her terminal status at the start of the second 90-day period. Medicare continues paying for all hospice services without interruption. Her family receives grief counseling for up to 13 months after her passing.
Scenario 2: Robert Changes His Mind About Hospice
Robert, age 81, has advanced heart failure. He elects hospice during his first 90-day benefit period. After four weeks, a new clinical trial opens up, and Robert wants to pursue curative treatment again.
| Robert’s Action | The Consequence |
|---|---|
| Submits written revocation on Day 30 of first 90-day period | Loses the remaining 60 days in that benefit period — they cannot be recovered |
| Returns to regular Medicare | Part A and Part B cover the clinical trial and hospital stays with standard deductibles and copays |
| Clinical trial doesn’t work; Robert re-elects hospice 4 months later | Begins a new benefit period — his second 90-day period starts |
| After second 90-day period, needs continued care | Moves to 60-day periods; must have face-to-face encounter for each recertification |
Robert’s case shows why understanding the revocation rules matters. Those 60 lost days are gone permanently. Families should discuss the decision carefully with the hospice team before revoking.
Scenario 3: Linda’s Mother Needs Crisis Care in a Nursing Home
Linda’s 88-year-old mother, Dorothy, has advanced Alzheimer’s disease and lives in a nursing home. Dorothy qualifies for hospice, and Linda enrolls her. Medicare covers Dorothy’s hospice services, but it does not cover room and board at the nursing home.
| Dorothy’s Situation | How Coverage Works |
|---|---|
| Enrolled in hospice while living in nursing home | Medicare pays hospice services; room and board paid by Medicaid, private insurance, or out-of-pocket |
| Experiences severe agitation crisis | Hospice provides continuous home care (crisis care) at the nursing home for 12 hours |
| Crisis can’t be controlled at the facility | Transferred to general inpatient care at a hospital; Medicare covers 100% |
| Dorothy stabilizes after 3 days | Returns to nursing home on routine home care level; hospice visits resume |
Dorothy’s case highlights the important distinction between hospice services and room and board. Many families are surprised to learn that Medicare’s hospice benefit does not cover the daily cost of living in a facility.
How Medicare Advantage Plans Handle Hospice
Medicare Advantage (Part C) plans have a complicated relationship with hospice care. Under the current hospice carve-out model, when a Medicare Advantage enrollee elects hospice, their hospice services are not paid by the MA plan. Instead, traditional fee-for-service Medicare pays for all hospice-related care.
The MA plan stops receiving inpatient and outpatient capitated payments for that enrollee but continues to receive premium and rebate payments. Part A and Part B services unrelated to the terminal illness continue to be paid by the MA plan. Part D prescription medications unrelated to the terminal condition are also still covered through the plan.
CMS tested a Value-Based Insurance Design (VBID) model beginning in 2021 that carved hospice into Medicare Advantage plans. This model expanded to more plans and counties over several years. CMS ended the VBID hospice carve-in in December 2024 following widespread dissatisfaction, returning fully to the carve-out model.
What This Means for MA Enrollees
If you’re enrolled in a Medicare Advantage plan and elect hospice, you stay in your MA plan. You don’t need to switch. Your hospice care simply gets billed to original Medicare instead of your MA plan. Any supplemental benefits your MA plan offers — like dental, vision, or hearing — may still be available to you, depending on your plan’s specific rules.
State Medicaid and Hospice: Who Pays for Room and Board?
Medicare’s biggest gap in hospice coverage is room and board. For patients living in nursing facilities, this cost can be thousands of dollars per month. Medicaid often fills this gap, but the rules vary by state.
Under federal Medicaid rules, states can cover room and board for dual-eligible patients — those who qualify for both Medicare and Medicaid. Most states do provide this coverage. For dual-eligible patients in a nursing home, Medicare pays for the hospice services while Medicaid pays the facility’s room and board at a rate set by the state.
Patients who are not dual-eligible must pay room and board out of pocket or through private long-term care insurance. This creates a significant financial burden for families, especially when a patient requires nursing home-level care for months. Some states have hospice Medicaid waiver programs that expand coverage for certain populations, but eligibility and benefits vary widely.
Hospice Fraud: A Growing Problem That Affects Patients
CMS referred 343 cases to law enforcement for suspected hospice fraud in 2025, representing $3.4 billion in fraudulent billing activity. Roughly 4,780 providers had their Medicare billing privileges revoked due to inappropriate behavior. Fraud hurts patients because it leads to stricter audits and more claim denials for legitimate hospice providers.
The most common forms of hospice fraud include enrolling patients who are not terminally ill, billing for services never provided, and keeping patients on hospice for extended periods solely to collect Medicare payments. The IMPACT Act of 2014 systemized audits of long hospice stays, and a 2016 two-tier payment system decreased daily reimbursement after 60 days to discourage unnecessary long enrollments.
Families should verify that their hospice provider is Medicare-certified and check their quality ratings on Medicare’s Care Compare tool. If a hospice pressures a patient to enroll or promises services that sound too good to be true, those are red flags for potential fraud.
Mistakes to Avoid When Using the Medicare Hospice Benefit
Understanding these common errors prevents claim denials, unexpected costs, and gaps in coverage.
Mistake 1: Not getting dual physician certification. Medicare requires both the attending physician and the hospice medical director to certify terminal illness. If only one physician signs, the claim will be denied. The denial rate for missing or invalid certifications accounts for 55% of all hospice claim denials.
Mistake 2: Going to the ER without calling the hospice team first. If you visit the emergency room without your hospice team arranging it, Medicare may not cover the cost. Always contact the hospice nurse or on-call team before seeking emergency services.
Mistake 3: Assuming room and board is covered. Many families are shocked when they receive a bill for nursing home room and board. Medicare’s hospice benefit explicitly excludes room and board costs.
Mistake 4: Verbally revoking hospice instead of doing it in writing. A verbal revocation is not valid under Medicare rules. The patient or representative must submit a signed, written statement with the effective date.
Mistake 5: Not understanding that revocation forfeits remaining days. When a patient revokes mid-period, they lose all remaining days in that benefit period. A patient in Day 10 of a 90-day period loses 80 days of coverage permanently.
Mistake 6: Missing the face-to-face encounter requirement. Starting with the third benefit period, a hospice physician or nurse practitioner must conduct a face-to-face visit to recertify terminal illness. Skipping this step results in automatic denial.
Mistake 7: Continuing curative treatment after electing hospice. Once you sign the hospice election statement, Medicare no longer covers treatments aimed at curing the terminal illness. Patients who receive curative treatment may have to pay the full cost out of pocket.
Pros and Cons of Electing the Medicare Hospice Benefit
| Pros | Cons |
|---|---|
| $0 cost for most hospice services including nursing, medication, and equipment | Must give up curative treatments for the terminal illness |
| Comprehensive care team: doctors, nurses, aides, therapists, social workers, chaplains | Room and board at nursing facilities is not covered |
| Grief and bereavement counseling for the family for up to 13 months after death | Revoking hospice means losing remaining days in that benefit period |
| No limit on how long you can receive hospice — unlimited 60-day periods after initial 6 months | Face-to-face recertification required every 60 days after the first two periods |
| Four levels of care allow flexibility as patient needs change | Emergency care without hospice team involvement may not be covered |
| Respite care gives family caregivers a needed break (up to 5 days at a time) | Small copays apply: up to $5 per prescription and 5% for respite care |
| Care is provided wherever you live — home, nursing home, or assisted living | Medicare Advantage supplemental benefits may change when hospice is elected |
Do’s and Don’ts of Medicare Hospice
Do’s
- Do make sure both your personal doctor and the hospice medical director certify your terminal illness before electing hospice. This dual certification is the single most important step in qualifying.
- Do contact your hospice team before going to the emergency room or seeking any outside medical care. The hospice team can arrange covered services and prevent out-of-pocket costs.
- Do ask about all four levels of care — routine, continuous, inpatient, and respite — so you know what’s available when needs change.
- Do verify that your chosen hospice is Medicare-certified by using the Medicare Care Compare tool. Non-certified hospices cannot bill Medicare.
- Do ask about Medicaid coverage for room and board if your loved one is in a nursing facility and financially qualifies as dual-eligible.
- Do keep all documentation organized, including the election statement, physician certifications, and any care plan changes.
Don’ts
- Don’t assume hospice means giving up all medical care. Medicare still covers treatment for conditions unrelated to the terminal illness under regular Part A and Part B.
- Don’t revoke hospice without fully understanding the consequences. Lost days in a benefit period cannot be recovered.
- Don’t try to revoke hospice verbally. It must be in writing with a signed statement and effective date.
- Don’t wait too long to elect hospice. Research shows that patients enrolled for at least 15-30 days save Medicare $6,430 per patient while receiving significantly better care.
- Don’t ignore a hospice provider’s quality ratings. Only about half of providers have Star Ratings available, so do your due diligence.
- Don’t sign the election statement if you aren’t sure. Ask the hospice team every question you have before committing.
Key Entities and Organizations You Should Know
CMS (Centers for Medicare & Medicaid Services) is the federal agency that administers the Medicare hospice benefit and sets all rules for eligibility, coverage, and payment. CMS also conducts fraud investigations and referred 343 cases to law enforcement in 2025 alone.
OIG (Office of Inspector General) is the federal watchdog that audits hospice providers. OIG investigations have found that agencies with weak documentation policies wrote millions in excess payments. Their reports directly influence CMS policy changes.
The Interdisciplinary Group (IDG) is the team of healthcare workers that delivers hospice care. The IDG includes physicians, nurses, social workers, chaplains, aides, and therapists. Every patient’s care is directed by a Plan of Care (POC) specific to their needs.
NHPCO (National Hospice and Palliative Care Organization) publishes the annual Facts and Figures report tracking hospice trends across the country. Their data shows Medicare paid hospice providers $23.7 billion for care delivered in 2022.
FAQs
Does Medicare pay 100% for hospice care?
Yes. Medicare covers most hospice services at no cost. Exceptions include up to $5 per outpatient prescription and 5% coinsurance for inpatient respite care stays.
Can I stay on hospice longer than six months?
Yes. There is no time limit. After two 90-day periods, Medicare covers unlimited 60-day periods as long as a doctor recertifies terminal illness.
Does Medicare Advantage cover hospice?
No. Hospice is carved out of Medicare Advantage. When you elect hospice, traditional fee-for-service Medicare pays for hospice services instead of your MA plan.
Can I go back to regular Medicare after choosing hospice?
Yes. You can revoke hospice in writing at any time and return to standard Medicare coverage, but you lose remaining days in that benefit period.
Does Medicare cover hospice in a nursing home?
Yes. Medicare pays for hospice services in a nursing home. It does not cover room and board, which must be paid by Medicaid, insurance, or out-of-pocket.
Do I need a referral to get hospice care?
No. Any doctor can certify terminal illness, but both your attending physician and the hospice medical director must sign the certification.
Does hospice cover grief counseling for family members?
Yes. Medicare’s hospice benefit includes bereavement counseling for family members for up to 13 months after the patient’s death at no cost.
Can I switch hospice providers?
Yes. You have the right to change your hospice provider once during each benefit period without losing your coverage or restarting the period.
Will Medicare cover an ambulance to the ER while on hospice?
No. Medicare will not cover ambulance or ER costs unless your hospice team arranges the transport or the visit is for a condition unrelated to your terminal illness.
Can a hospice kick me off their services?
Yes. A hospice can discharge you if you are no longer terminally ill, move out of the service area, or pose a safety risk, but they cannot revoke your election.
Related reading
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- Do Long Term Care Policies Have a Death Benefit? (w/Examples) + FAQs
- Does Long-Term Care Insurance Cover Hospice? (w/Examples) + FAQs
- How Does Medicare Part D Work (w/Examples) + FAQs
- Does Medicare Part B Cover a Skilled Nursing Facility? (w/Examples) + FAQs
- Does Hospice Do Estate Recovery? (w/Examples) + FAQs
- Is Nationwide Long-Term Care Insurance Worth It? (w/Examples) + FAQs