Medicare guidelines for hospice

Medicare provides a dedicated hospice benefit to help people with terminal illnesses receive compassionate, comfort-focused care. But there are specific rules around eligibility, services covered, and costs.

Quick Definition

Medicare Part A covers hospice care for people with a life expectancy of six months or less who choose palliative (comfort) care over curative treatment.

Who Is Eligible for Hospice Under Medicare

• To qualify, two doctors must certify that you are terminally ill (life expectancy of about six months or less). 

• You or a representative must sign a statement electing the hospice benefit and accept comfort care instead of treatments aimed at curing the illness. 

• You must receive care from a Medicare-approved hospice provider. 

• After the initial benefit periods, your hospice care can continue, as long as your hospice medical director or doctor recertifies that your life expectancy remains six months or less. 

What Services Medicare Covers Under Hospice

Medicare’s hospice benefit covers a comprehensive set of services designed to reduce pain and manage symptoms:

• Physician and nursing care 

• Medical equipment and supplies (like hospital beds or oxygen) 

• Drugs for pain and symptom control, not for curing the terminal illness 

• Hospice aides and homemaker services (help with daily personal care) 

• Physical, occupational, or speech therapy for comfort purposes 

• Social services, spiritual counseling, and grief support 

• Short-term inpatient care:

  • Respite care (to give the primary caregiver a rest) 

  • General inpatient care when intense symptom management is needed 

What Medicare Does Not Cover Under Hospice

• Treatments intended to cure the terminal illness or manage related conditions with curative intent. 

• Prescription drugs for curing the illness.

• Care from providers not authorized by your hospice team. 

• Room and board: Medicare doesn’t pay for the “room and board” if you stay in a facility like a nursing home, unless it’s for a very short-term inpatient stay arranged by hospice. 

• Hospital outpatient or inpatient care, and ambulance transport, unless arranged by your hospice team or for a condition unrelated to the terminal illness. 

Your Costs with Medicare Hospice

• There’s no Medicare deductible for hospice services. 

• You may pay up to $5 for each outpatient prescription used to manage symptoms or pain. 

• For inpatient respite care, you pay 5% of the Medicare-approved amount, capped at the yearly inpatient hospital deductible.

• If you have Medicare Advantage (Part C), the hospice benefit is still handled by Original Medicare once hospice care begins. 

How Hospice Care Is Organized

• Your hospice care team includes a variety of professionals: doctors, nurses, social workers, aides, volunteers, and others. 

• Medicare recognizes four levels of hospice care:

  1. Routine home care — normal day-to-day care at home or in a facility. 

  2. Continuous home care — intensive nursing during crises at home. 

  3. Respite care — temporary inpatient stay (up to 5 days) so caregivers can rest. 

  4. General inpatient care — when symptoms require inpatient management. 

Special Notes & Common Questions

• If you’re on a Medicare Advantage plan, hospice is not covered by that plan — Medicare Original takes over for hospice care. 

• You do not lose your Medicare Part A or Part B benefits when you enroll in hospice. 

• Some hospice services not related to the terminal illness (for example, treating an unrelated infection) may still be covered by Original Medicare. 

• Your hospice team must create a plan of care that matches your physical, emotional, and social needs, and you or your family gets to be part of that process. 

Final Summary

Medicare (Part A) offers a solid hospice benefit for those with a terminal illness and a six-month life expectancy, focusing on comfort care rather than cure. It covers a broad range of services — from nursing and medications for symptom relief, to aides, social support, and respite care — with low out-of-pocket costs. However, it does not pay for curative treatments, room and board in some settings, or services from non-hospice-approved providers.

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