Short answer: The Medicare hospice benefit covers nursing, medications, equipment, and support related to a terminal illness at essentially no cost to the patient. To qualify, two doctors must certify a prognosis of six months or less, and the patient must choose comfort care over curative treatment. Most families pay $0 for hospice itself, with two small exceptions: a $5 drug copay and a 5% coinsurance for inpatient respite stays.
- Medicare Part A covers hospice care once a doctor certifies a terminal prognosis of six months or less.
- Coverage includes nursing, aide visits, medications, equipment, and grief support for the family.
- There are four levels of care: routine home care, continuous home care, general inpatient care, and respite care.
- Out-of-pocket costs are minimal: a $5 copay per drug and a 5% coinsurance for inpatient respite stays.
- You can revoke the hospice benefit at any time and return to it later if you remain eligible.
- This is different from the length of coverage itself. See our guide on how long Medicare pays for hospice care for benefit period details.
Who Is Eligible for the Medicare Hospice Benefit?
To elect the Medicare hospice benefit, you need to meet a few requirements. You must be enrolled in Medicare Part A. A hospice physician and your attending physician (if you have one) must certify that you have a life expectancy of six months or less if the illness runs its normal course. And you, or your authorized representative, must choose hospice, which means agreeing to focus on comfort care instead of treatment aimed at curing the terminal illness.
Hospice isn’t only for cancer patients. People with heart failure, COPD, dementia, kidney disease, and other advanced illnesses can qualify, as long as the prognosis meets the six-month standard. If you’re still weighing hospice against other options, our hospice vs. palliative care guide breaks down the difference.
What Does the Medicare Hospice Benefit Cover?
Once you elect hospice, Medicare covers a wide range of services related to your terminal illness and related conditions, according to CMS. Covered services include:
- Physician and nurse practitioner services from the hospice team
- Nursing care
- Medical social services
- Home health aide and homemaker services
- Medications for pain and symptom management related to the terminal illness
- Medical equipment and supplies, such as hospital beds, wheelchairs, and oxygen
- Physical, occupational, and speech therapy for comfort
- Spiritual and grief counseling for the patient and family, before and after death
- Short-term inpatient care for pain control and symptom management
After you elect hospice, you can still get Medicare coverage for health problems unrelated to your terminal illness. Your hospice provider can tell you why they consider a specific service related or unrelated to your terminal diagnosis.
What Are the Four Levels of Hospice Care?
Medicare pays hospice agencies a daily rate based on one of four levels of care, and patients can move between levels as their needs change.
| Level of Care | When It’s Used | Where It Happens |
|---|---|---|
| Routine Home Care | Day-to-day care for most patients, most of the time | Wherever the patient calls home |
| Continuous Home Care | During a symptom crisis requiring intensive nursing | At home, for up to 24 hours a day |
| General Inpatient Care | Short-term management of symptoms that can’t be controlled at home | Hospice facility, skilled nursing facility, or hospital |
| Respite Care | Short-term relief for the family caregiver | Approved inpatient facility, up to 5 consecutive days |
Most patients spend most of their time on Routine Home Care. The other three levels are available when a patient’s needs change, and your hospice team continually assesses which level fits your situation. If you want more detail on the respite benefit specifically, see our guide on whether Medicare covers respite care.
What Might a Family Still Pay?
For most families, hospice care itself costs $0 under Medicare. There are two small exceptions:
- Outpatient prescription drugs. A copay of up to $5 per prescription for medications related to pain and symptom management.
- Inpatient respite care. A coinsurance of 5% of the Medicare-approved amount, capped at the inpatient hospital deductible for the year.
Medicare does not cover room and board if you receive hospice care at home or live in a nursing home or hospice residential facility, except during a covered short-term inpatient or respite stay that your hospice team arranges. Some families qualify for additional help with room and board costs through Medicaid, depending on the state.
Medications and Equipment: What’s Included?
Your hospice plan of care typically includes medications and durable medical equipment related to your terminal illness and comfort, such as pain medications, hospital beds, wheelchairs, and oxygen. Your hospice team arranges and coordinates delivery of these supplies as part of your daily hospice rate. If you’re prescribed a medication your hospice team determines is unrelated to your terminal diagnosis, that may be billed under your regular Medicare drug coverage instead.
How Does Revocation and Discharge Work?
You can revoke your hospice election at any time, for any reason, according to the Medicare Benefit Policy Manual. To revoke, you or your representative files a signed statement indicating you no longer want hospice coverage for the remainder of the current benefit period. You lose the remaining days in that period, but your regular Medicare coverage resumes immediately, and you can re-elect hospice later if you continue to meet eligibility criteria.
A hospice can also discharge a patient in specific situations: if the patient is no longer considered terminally ill, if the patient moves out of the hospice’s service area, or for cause under the hospice’s internal policy. A hospice cannot discharge a patient simply because care has become more costly or time-consuming.
Services Unrelated to the Terminal Diagnosis
Electing hospice doesn’t mean giving up all other Medicare coverage. Care for conditions unrelated to your terminal illness, such as a broken bone from a fall or a routine flu shot, is generally still covered under your regular Medicare benefits. You can ask your hospice provider for a list of items and services they’ve determined aren’t related to your terminal diagnosis, along with the reasoning behind that determination.
Understanding what the Medicare hospice benefit covers can make a confusing time a little clearer. If you have questions about how this applies to your family’s specific situation, your local Suncrest hospice team can walk through your coverage and answer questions about your plan of care.
Frequently Asked Questions
Does the Medicare hospice benefit ever expire?
No. As long as a hospice physician continues to certify that the patient meets the terminal prognosis requirement, the benefit does not have a fixed end date. Coverage continues through repeating benefit periods.
Can I keep seeing my regular doctor while on hospice?
Yes, for anything unrelated to your terminal illness. For your terminal illness itself, your hospice medical team generally takes over care, though you can still name your attending physician as part of your hospice team.
Does Medicare cover hospice care in a nursing home?
Medicare covers the hospice services themselves in a nursing home. It generally does not cover room and board there, though some patients have additional coverage through Medicaid depending on their state.
What happens if I revoke hospice and then want it back?
You can re-elect the hospice benefit at any time, as long as you continue to meet the eligibility requirements, including a physician’s certification of a six-month or less prognosis.
Is this the same as asking how long Medicare pays for hospice?
Not quite. This guide covers what’s included in the benefit and what it costs. For details on benefit periods and how long coverage can continue, see our separate guide on how long Medicare pays for hospice care.
