What Medicare Hospice Covers and How the Benefit Election Works

Medicare hospice coverage is one of the most comprehensive benefits in the program, designed to support individuals and families during end-of-life care. It covers an extensive range of services that most families pay out of pocket without realizing Medicare would cover them. But hospice comes with a specific election that most people do not fully understand until they are in a difficult moment. Knowing what hospice covers, what it requires, and what you give up when you elect it helps families make informed decisions without added confusion during an already hard time.

Bryce's Take

Hospice conversations are some of the most important ones I have with families. People do not know what Medicare covers, they assume the costs are significant, and they sometimes delay a decision that would have provided much more comfort earlier. Medicare hospice coverage is comprehensive and the cost-sharing is minimal. If your family is facing this conversation, understanding the coverage is a productive first step.

What Medicare hospice covers

When you elect Medicare hospice, Part A covers an extensive list of services aimed at comfort and symptom management rather than cure. Covered services include physician visits for the terminal illness, skilled nursing care, medical social services, home health aide services, counseling (including bereavement counseling for the family after death), spiritual care, medications related to the terminal diagnosis for pain relief and symptom control, medical equipment like hospital beds and wheelchairs at home, short-term inpatient care at a hospital or nursing facility for pain control, and respite care, temporary inpatient stays to give caregivers a break, covered up to five consecutive days per episode.

The hospice election and what it means

To receive Medicare hospice benefits, you must file a hospice election with a Medicare-certified hospice program. A physician must certify that you have a terminal illness with a life expectancy of six months or less if the illness runs its normal course. When you elect hospice, you agree to receive palliative rather than curative care for the terminal diagnosis. You generally cannot continue treatments aimed at curing or managing the terminal illness through Medicare while on hospice, these become the hospice's responsibility to manage within their benefit.

What remains covered outside of hospice

Electing hospice does not affect Medicare coverage for conditions unrelated to the terminal diagnosis. If you have a hospice election for cancer and break your hip, Medicare covers the hip treatment. Emergency care for the terminal illness is also covered if it is not related to hospice services. Your Medicare Advantage or supplemental coverage continues for non-hospice-related services.

Hospice benefit periods

The Medicare hospice benefit is organized into benefit periods: two initial 90-day periods, followed by unlimited 60-day periods. At the beginning of each period, a hospice physician must recertify that your prognosis remains six months or less. There is no limit on the number of 60-day periods, meaning hospice coverage can extend well beyond six months if the individual remains appropriate for hospice care. You can revoke the hospice election at any time if you decide to pursue curative treatment.

Have questions about hospice coverage for yourself or a family member?

Hospice benefits and how they interact with your existing Medicare coverage can be complex to navigate, especially in difficult circumstances. I am glad to help explain what Medicare covers.

Book a Free Call

The cost to you

Medicare hospice coverage has minimal cost-sharing. There is no deductible. Patients may pay up to 5% of the cost of outpatient drugs or $5 per drug prescription, whichever is less, though many hospices waive even this. Respite care requires a 5% coinsurance capped at the inpatient Medicare deductible amount. Room and board in a nursing facility is not covered by Medicare hospice, though Medicaid covers it for qualifying individuals receiving nursing home hospice care.

Hospice under Medicare Advantage

Starting in 2021, Medicare Advantage plans began providing some hospice coordination through the new VBID hospice model. In most standard cases, Medicare Part A pays for hospice directly even if you have Medicare Advantage. Your Advantage plan continues to cover non-hospice conditions. This is an area of Medicare policy that is evolving, and specific arrangements may vary by plan and enrollment year.

Frequently asked questions

Can someone be on hospice for more than six months?

Yes. The six-month prognosis is required for election, but people sometimes live longer than expected. Hospice coverage continues as long as a physician recertifies at each benefit period that the prognosis remains six months or less. Many hospice patients remain enrolled for much longer than six months.

Can a person leave hospice if they improve?

Yes. The hospice election can be revoked at any time. When revoked, Medicare returns to normal coverage for all conditions, including resuming curative treatment for the terminal diagnosis. A person can also return to hospice later if they again meet the eligibility criteria.

Does hospice care happen only at home?

Hospice care is primarily provided at home, but hospice patients can also receive inpatient hospice care at a Medicare-certified inpatient hospice facility, hospital, or skilled nursing facility when pain or symptoms cannot be managed at home. Respite care provides temporary inpatient stays for caregiver relief.

What does Medicare pay the hospice provider?

Medicare pays the hospice a per-diem rate for each type of hospice care day (routine home care, continuous home care, inpatient respite care, or general inpatient care). The hospice is then responsible for providing all covered services within that payment. This is why hospice is responsible for medications related to the terminal diagnosis, they are bundled into the per diem.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.