The numbers worth knowing.
Here's what to do, in 4 steps.
Hospice election is consequential and reversible. The four steps below are the ones I walk families through before anyone signs anything. Take them in order. Slow is fine.
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Talk to a palliative-care physician first
Before anyone signs the hospice election form, ask the treating doctor (or the hospital) for a palliative-care consult. Palliative care is broader than hospice and is not an either-or with curative treatment. It often helps families think through whether hospice election makes sense yet, or whether comfort-focused care alongside ongoing treatment is the better fit.
Time: Same week Cost: Free Medicare hospice care overview
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Get the certification details in writing
Hospice eligibility requires written certification from two physicians for the initial 90-day period: the hospice medical director (or designee) and the patient's attending physician. Ask for copies. The certification must state the prognosis is six months or less if the disease runs its normal course — it is a medical judgment, not a deadline.
Time: Same day Cost: Free 42 CFR 418.22 — certification of terminal illness
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Ask what counts as 'related' to the terminal illness
When you elect hospice, Medicare waives payment for treatment aimed at curing the terminal illness or anything the hospice considers related. The line is not always obvious. Ask the hospice for the election statement addendum (a written list of items they consider unrelated and won't cover). You have the right to request it. Read it before you sign.
Time: Same week Cost: Free 42 CFR 418.24 — election statement and addendum
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Know your right to revoke and re-elect
Hospice election is not permanent. The patient (or their representative) can revoke the election at any time and return to standard Medicare. They can also re-elect later for any benefit period that's still available. Call your hospice's social worker or your local SHIP at 1-877-839-2675 if you need help thinking through whether to revoke.
Time: Same day Cost: Free Medicare hospice care — your rights
Dr. Ed explains the Medicare hospice benefit
Video coming soon
I'm filming a walkthrough of the hospice benefit — what it covers, what the four levels of care look like, and the questions to ask before electing. Sign up below and I'll send it when it's ready.
Which of these sounds more like you?
Hospice questions look different depending on where the family is in the process. Pick the situation that sounds most like yours.
I'm considering hospice but haven't elected yetDoctor mentioned the option; family is starting to think about it
This is the most common place to be. The treating doctor has raised hospice or said curative options are running out, and the family is trying to figure out what hospice actually means.
A few things worth knowing before you decide. First, hospice election is reversible — you can revoke at any time and go back to standard Medicare. Second, the six-month prognosis is a medical judgment about a normal disease course; people sometimes outlive it, and the benefit continues with recertification. Third, you do not have to elect hospice to start palliative care — palliative-care physicians can help families think this through before any formal election.
If you're not ready, that's fine. Ask for a palliative-care consult first. The hospice election can wait.
If the conversation hasn't happened yet, start with the treating doctor. → Find a palliative-care consult
We already elected hospice and want to know what's coveredElection form signed; family wants to understand the benefit
Once hospice is elected, Medicare covers a wide range of services with essentially no cost-sharing. The hospice provides nursing, physician services, aide and homemaker help, social work, counseling (including spiritual care), durable medical equipment, and drugs for symptom and pain management.
The two cost-sharing exposures are small. The hospice may charge up to $5 per prescription for outpatient palliative drugs. Inpatient respite care has a 5% coinsurance per day (with an annual cap tied to the inpatient hospital deductible). Everything else hospice-related is covered.
Medicare still covers care for unrelated conditions — a broken hip, for instance, or a chronic condition that has nothing to do with the terminal diagnosis. Ask the hospice for the election statement addendum if you want their list of what they consider unrelated.
If you haven't elected yet, the prior card is more relevant. → See pre-election questions
Mom has been on hospice longer than six monthsFirst two 90-day periods are passing; family is worried
This happens often, and it is not a problem. The hospice benefit is structured around recertification, not a hard six-month deadline.
The benefit periods go in a specific order: an initial 90-day period, a second 90-day period, then an unlimited number of 60-day periods. At each transition, a hospice physician (or nurse practitioner, starting with the third period) recertifies that the prognosis remains six months or less if the illness runs its normal course. As long as that medical judgment holds, the benefit continues.
If the patient improves enough that the prognosis no longer fits, the hospice will discharge them. They can re-elect later if their condition changes again. None of this requires the patient to do anything other than continue receiving care.
If your hospice has signaled discharge, the appeals card may apply. → See coverage denial appeals
I want to know what I'm giving up by electing hospiceWorried about waiving curative treatment
When you elect hospice, you waive Medicare payment for two specific things: care from any hospice other than the one you designated, and any Medicare services aimed at curing the terminal illness or anything the hospice considers related to it.
You do not waive Medicare for unrelated conditions. If your terminal diagnosis is cancer and you break your wrist, Medicare still covers the wrist. If you have unrelated diabetes management, Medicare still covers that.
The phrase that trips people up is 'related conditions.' The hospice decides what counts as related. Since 2020, hospices must offer a written addendum listing items, services, and drugs they consider unrelated and won't cover — ask for it. If you disagree with their determination, you have immediate-advocacy rights through the Beneficiary and Family Centered Care Quality Improvement Organization.
If you've already had a service denied, the appeals card has more detail. → See Medicare coverage appeals
I'm in a Medicare Advantage plan — does hospice work differently?Wondering whether to switch back to Original Medicare
When a Medicare Advantage enrollee elects hospice, Original Medicare — not the Advantage plan — pays the hospice provider for hospice services. The MA enrollment continues; the hospice payment just routes through Original Medicare instead.
For non-hospice care during the same time period, the rules can vary. Care that's clearly unrelated to the terminal illness usually still flows through the MA plan. Care that's borderline can get tangled. Ask the hospice's billing office and your MA plan's care coordinator both — in writing — how they're handling specific services.
You can also disenroll from MA back to Original Medicare during a hospice election if it simplifies things. Talk to SHIP first.
If you're already in Original Medicare, this card doesn't apply. → See Original Medicare hospice basics
I'm the caregiver and I'm exhausted — can hospice help?Family caregiver burnout is real and the benefit accounts for it
Yes. The hospice benefit includes inpatient respite care — short-term inpatient care provided specifically to give the family caregiver a break.
Respite care can be furnished for up to five consecutive days at a time, in a Medicare-certified hospice facility, hospital, or skilled nursing facility. The patient is admitted, cared for by clinical staff, and the family caregiver gets several days to rest, travel, or just sleep.
Cost-sharing for respite is small: 5% of the Medicare-approved amount per day, capped at the inpatient hospital deductible per coinsurance period. Ask your hospice's social worker to set it up. Don't wait until you're at the breaking point — respite is built into the benefit precisely because caregiver exhaustion is part of this.
If you need full-time care at home (not respite), the continuous-care level may apply. → See the four levels of hospice care
I'm helping a parent through thisYou're the family caregiver or representative
Walking a parent or spouse through hospice election is one of the hardest things a family does. You don't have to memorize the rules.
The basics: a hospice physician (or designee) plus the patient's attending physician must certify the prognosis is six months or less if the illness runs its normal course. The patient (or their representative, if they're incapacitated) signs the election form. The hospice provides comprehensive care — nursing, aides, social work, counseling, equipment, and drugs for symptom management. There's no real cost beyond a small drug copay and small respite coinsurance.
What to ask the hospice's social worker: what's the four-levels-of-care plan, what's on the election addendum (the list of items they consider unrelated), how do we request respite, and what bereavement support is available for the family afterward.
You'll get more right than wrong if you take it slow.
If you're filing for yourself, the earlier cards apply. → See pre-election questions
None of these quite fit my situationEnd-of-life care decisions don't always fit a clean category
Hospice questions are some of the most personal decisions in Medicare, and the situations don't always fit the typical categories — a child caring for two parents at once, an out-of-state move during election, a complex MA-and-Medicaid dual-eligible scenario, a non-cancer terminal diagnosis where the trajectory is harder to predict.
If nothing above describes you, here are the right people to call. Your hospice's social worker is the closest expert and is paid to help. SHIP at 1-877-839-2675 is free and independent. The Center for Medicare Advocacy publishes detailed guides on hospice rights and can connect you with legal help if a coverage dispute escalates. A palliative-care physician (often available through the hospital that referred you) is the right person to talk to before any formal election if the medical picture is uncertain.
Hospice decisions are not the kind of thing to figure out alone.
Most people find one of the cards above fits. → Back to top
Everything people ask me about hospice
Who qualifies for the Medicare hospice benefit?
Anyone with Medicare Part A whose hospice medical director (or designee) and attending physician both certify a prognosis of six months or less if the terminal illness runs its normal course. The patient (or representative, if the patient is incapacitated) must sign an election statement choosing comfort-focused care over curative treatment for that illness.
What does the Medicare hospice benefit actually cover?
Hospice covers nursing care, physician services, hospice aide and homemaker services, medical social services, counseling (including dietary, spiritual, and bereavement), short-term inpatient and respite care, durable medical equipment, medical supplies, drugs for symptom and pain control related to the terminal illness, physical/occupational/speech therapy for symptom management, and any other service identified in the plan of care that Medicare would otherwise cover.
What does hospice NOT cover?
Hospice does not cover treatment intended to cure the terminal illness, care from a hospice you didn't designate, or room and board in a facility (unless you're receiving inpatient respite or general inpatient hospice care). Medicare also stops paying for any other services it considers related to the terminal illness during your hospice election. Medicare still pays for unrelated conditions — a broken bone, an unrelated chronic illness — normally.
What are the four levels of hospice care?
Routine home care — the most common level, day-to-day hospice services delivered wherever the patient lives. Continuous home care — nursing care up to 24 hours a day during a medical crisis to keep the patient at home. Inpatient respite care — short-term inpatient stay (up to 5 consecutive days at a time) so the family caregiver can rest. General inpatient care — inpatient stay for pain control or symptom management that can't be managed at home. The hospice's interdisciplinary team decides which level fits the patient's current needs.
What if Mom outlives the six-month prognosis?
Nothing bad happens. The hospice benefit is structured around recertification, not a hard deadline. Coverage runs in benefit periods: an initial 90 days, a second 90 days, then unlimited 60-day periods. At each transition, a hospice physician (or nurse practitioner from the third period on) recertifies that the prognosis still meets the six-month standard if the illness runs its normal course. As long as the medical judgment holds, the benefit continues.
Can I revoke hospice and go back to standard Medicare?
Yes. The patient (or representative) can revoke the hospice election at any time and return to standard Medicare coverage. After revocation, the patient can re-elect hospice later for any benefit period that's still available — the periods are used in order, but a revocation doesn't burn the rest of the benefit.
How much does hospice cost out of pocket?
Almost nothing for most people. The hospice may charge up to $5 per outpatient prescription for drugs related to pain and symptom management. Inpatient respite care has a 5% coinsurance per day, capped at the inpatient hospital deductible per coinsurance period. There is no other cost-sharing for hospice-covered services.
Will hospice cover Mom's medications?
Hospice covers drugs used primarily for relief of pain and symptom control related to the terminal illness, including drugs delivered in the home. Drugs for unrelated conditions are not covered by hospice and would continue under Part D or whatever coverage the patient already has. The hospice may charge up to $5 per outpatient palliative prescription.
Does Medicare cover bereavement support for the family?
Yes. The hospice is required to make bereavement counseling available to the family and other individuals identified in the bereavement plan of care for up to one year after the patient's death. Bereavement counseling is a required hospice service, even though it isn't separately reimbursed by Medicare — it's part of what the hospice provides.
I've heard children can get hospice and curative care at the same time — does that apply to my parent?
No. The concurrent-care rule (Affordable Care Act Section 2302) applies only to children under 21 covered by Medicaid or CHIP. It does not apply to adult Medicare beneficiaries, even those who are dual-eligible. For adults on Medicare hospice, electing hospice means waiving Medicare payment for curative treatment of the terminal illness during the election. Children covered by Medicaid or CHIP are the carve-out; adults are not.
Programs that often run alongside hospice.
Hospice rarely sits alone. Families navigating end-of-life care often touch several other programs at the same time. Here are the ones I see most often.
Medicare Part A
Part A is what funds the hospice benefit. If you have Medicare Part A, the hospice benefit is available to you when a hospice physician and the attending physician certify a prognosis of six months or less if the illness runs its normal course.
Medicare Home Health Coverage
If the patient is homebound but does not have a six-month-or-less terminal prognosis, Medicare home health may be the right pathway instead of hospice. The two benefits cover different populations.
Medicare Skilled Nursing Facility Coverage
Some families look at hospice and skilled nursing facility care side by side. Medicare SNF coverage requires a qualifying inpatient hospital stay and skilled-care need; it is a different pathway and the two have different rules and different cost-sharing.
Medicare Coverage Denial Appeals
If a hospice tells you something is 'related' to the terminal illness and you believe it should be covered separately, you have appeal rights. Immediate advocacy through the Beneficiary and Family Centered Care Quality Improvement Organization is the first step.
Medicaid (long-term care)
Patients with limited income may also qualify for Medicaid long-term-care coverage, which can pay for room and board in a facility (something Medicare hospice does not cover). Dual-eligible families should ask the hospice social worker about coordination.
SHIP (free Medicare counseling)
Every state has a State Health Insurance Assistance Program offering free, independent Medicare counseling. SHIP counselors regularly help families navigate hospice coverage and MA-coordination questions. Call 1-877-839-2675.
Help me keep it.
I write about Medicare's quieter rules — the ones that change with little fanfare and trip people up later. If that's useful, I'll send updates when something material moves.
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