Medicare Hospice Benefits: Coverage, Costs, and Patient Choices

Adapted from Medicare Hospice Benefits, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Hospice Care

Choosing to start hospice care is a difficult decision. The information in this booklet, support from a doctor, and a trained hospice care team can help you choose the most appropriate health care options if you’re terminally ill.

Hospice is a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families. Hospice isn’t only for people with cancer. If you get hospice care:

• The focus is on comfort (palliative care), not curing an illness.
• Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions.
• A specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs.
• You get care generally in the home.
• Family caregivers can get support.

Palliative care

Palliative care is the part of hospice care that focuses on helping people who are terminally ill and their families maintain their quality of life. If you’re terminally ill, palliative care can address your physical, intellectual, emotional, social, and spiritual needs. Palliative care supports your independence, access to information, and ability to make choices about your health care.

Care for a condition other than your terminal illness

Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, Original Medicare will cover everything you need related to your terminal illness, even if you remain in a Medicare Advantage Plan or other Medicare health plan.

After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren’t part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren’t part of your terminal illness and related conditions.

Important: If you were in a Medicare Advantage Plan before starting hospice care, and decide to stay in that plan, you can get covered services for any health problems that aren’t part of your terminal illness and related conditions. For more information on hospice care if you’re in a Medicare Advantage Plan or other Medicare health plan, go to page 7.

Note: You can ask your hospice provider for a list of items, services, and drugs that they’ve determined aren’t related to your terminal illness and related conditions. This list must include why these items, services, and drugs aren’t related to your terminal illness and related conditions. Your hospice provider must also give this list to your non-hospice providers or Medicare if asked.

How your hospice benefit works

If you qualify for hospice care, you and your family will work with your hospice provider to set up a plan of care that meets your needs. If you joined a Medicare Advantage Plan before you entered hospice and choose to stay in it, your plan must give you a list of approved hospice providers in your service area. For more specific information on a hospice plan of care, call your state hospice organization. Call 1-800-MEDICARE (1-800-633-4227) for your state’s number. TTY users can call 1-877-486-2048.

You and your family members are part of a team that may also include:

• Doctors
• Nurses or nurse practitioners
• Counselors
• Social workers
• Pharmacists
• Physical and occupational therapists
• Speech-language pathologists
• Hospice aides
• Homemakers
• Volunteers

In addition, a hospice nurse and doctor are on call 24 hours a day, 7 days a week to give you and your family support and care when you need it.

A hospice doctor is part of your medical team. You can choose to include your regular doctor, a nurse practitioner, or a physician assistant on your medical team as the attending medical professional.

The hospice benefit allows you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility. If your hospice provider decides you need inpatient hospice care, your hospice provider will make the arrangements for your stay.

Who’s eligible for the hospice benefit

If you have Medicare Part A (Hospital Insurance) AND meet all of these conditions, you can get hospice care:

• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (you’re expected to live 6 months or less).
• You accept comfort care (palliative care) instead of care to cure your illness.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. If you choose hospice care, you have the right to change your mind and stop getting hospice care to get treatments for your terminal illness.

Note: Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have 6 months or less to live.

Finding a hospice provider

To find a hospice provider:

• Talk to your doctor.
• Visit Medicare.gov/care-compare to find Medicare-approved hospice providers in your area and compare them based on the quality of care they provide.
• Call your state hospice organization. Call 1-800-MEDICARE (1-800-633-4227) to get the number for your state hospice organization. TTY users can call 1-877-486-2048.

Medicare only covers your hospice care if the hospice provider is Medicare approved. If you belong to a Medicare Advantage Plan and want to start hospice care, your plan must help you locate a Medicare-approved hospice provider in your area.

What Medicare covers

Before you start hospice care, you can get a one-time only consultation with a hospice medical director or hospice doctor to talk about your care options and how to manage your pain and symptoms. You can get this one-time consultation even if you decide not to get hospice care.

Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice provider.

Hospice care is usually given in your home, but it may also be covered in an inpatient facility (like a hospice inpatient facility, Medicare participating hospital, or a skilled nursing facility). Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:

• Doctor services
• Nursing care
• Medical equipment (like wheelchairs or walkers)
• Medical supplies (like bandages and catheters)
• Prescription drugs (for pain and symptom control)
• Hospice aide and homemaker services
• Physical and occupational therapy
• Speech-language pathology services
• Social worker services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care (for pain and symptom management)
• Short-term respite care
• Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

Note: If you pay out of pocket for an item or service your doctor ordered, but your hospice provider refuses to give it to you, you can file an appeal with Medicare. Contact your State Health Insurance Assistance Program (SHIP) if you need help filing or understanding an appeal. For more information on filing a claim or an appeal, visit Medicare.gov/claims-appeals or call 1-800-MEDICARE.

Respite care

If your usual caregiver (like a family member) needs rest, you can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.

What your hospice benefit won’t cover

When you start hospice care, you’ve decided that you no longer want care to cure your terminal illness and related conditions, and/or your doctor has determined that efforts to cure your illness aren’t working. Once your hospice benefit starts, it won’t cover:

• Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you’re thinking about getting treatment to cure your illness. You always have the right to stop hospice care at any time.
• Prescription drugs that aren’t for your terminal illness or related conditions. These drugs aren’t included in the hospice benefit. However, they may be covered by your Medicare drug coverage (Part D), and you may have a copayment.
• Care from any provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. The hospice team must give or arrange all care you get for your terminal illness and related conditions. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor, nurse practitioner, or physician assistant, if you’ve chosen him or her to be the attending medical professional.
• Room and board. Your hospice benefit doesn’t cover room and board. However, if the hospice team determines you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
• Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unrelated to your terminal illness and related conditions, unless your hospice team arranges it.

Note: Contact your hospice team before you get any of these services, or you might have to pay the full cost.

Hospice care if you’re in a Medicare Advantage Plan or other Medicare health plan

Once you start getting hospice care, Original Medicare will cover everything you need related to your terminal illness, even if you choose to stay in a Medicare Advantage Plan or other Medicare health plan.

If you were in a Medicare Advantage Plan before starting hospice care, you can stay in that plan as long as you pay your plan’s premiums. If you choose to stay in your plan, your plan will cover:

• Any extra services that are medically necessary (like dental and vision benefits).
• Covered services for health problems that aren’t related to your terminal illness. You have the option to get these services from Original Medicare, or your Medicare Advantage Plan. If you get them from Original Medicare you may have to pay a copayment. If you get them from your plan (like getting them from a network provider if you’re in an HMO plan), you’re only responsible for your plan’s copayment. If you paid a copayment under Original Medicare, keep your receipts. Your plan must reimburse you for the extra amount you paid.
• If your Medicare Advantage Plan includes drug coverage, you’re covered by the plan for drugs not related to your terminal illness.

If your plan doesn’t cover services from out-of-network providers, Original Medicare will cover services that aren’t related to your terminal illness.

For more information about Original Medicare, Medicare Advantage Plans, and other Medicare health plans, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Information about Medicare Supplement Insurance (Medigap) policies

If you have a Medigap policy, it will cover your hospice costs for drugs and respite care. Your Medigap policy will also help cover health care costs for problems that aren’t part of your terminal illness and related conditions. Call your Medigap policy or your State Health Insurance Assistance Program (SHIP) for more information. To find the contact information for your SHIP, visit shiphelp.org or call 1-800-MEDICARE.

To get more information about Medigap policies, visit Medicare.gov or call 1-800-MEDICARE.

What you pay for hospice care

Medicare pays the hospice provider for your hospice care. There’s no deductible. You’ll pay:

• Your monthly Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) premiums.
• A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management. In the rare case the hospice benefit doesn’t cover your drug, your hospice provider should contact your Medicare drug plan (if you have one) to find out if your plan covers it.
• 5% of the Medicare-approved amount for inpatient respite care. For example, if Medicare approves $100 per day for inpatient respite care, you’ll pay $5 per day and Medicare will pay $95 per day. The amount you pay for respite care can change each year.

Note: Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will also pay for covered services for any health problems that aren’t part of your terminal illness and related conditions.

Important: If you need to get inpatient care at a hospital for your terminal illness and/or related conditions, your hospice provider must make the arrangements. Your hospice benefit will cover the cost of your inpatient hospice care in the hospital and pay your hospice provider. Since the hospice provider and the hospital have a contract, they work out the payment between them. However, if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care.

How long you can get hospice care

Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill.

Hospice care is given in benefit periods. You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. A benefit period starts the day you begin to get hospice care, and it ends when your 90-day or 60-day benefit period ends. At the start of the first 90-day benefit period, your hospice doctor and your regular doctor (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less).

Important: At the start of each benefit period after the first 90-day benefit period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care. Once your hospice benefit starts, you don’t need to “re-choose” hospice care for each new benefit period.

Note: You have the right to change your hospice provider once during each benefit period.

Stopping hospice care

If your health improves or your illness goes into remission, you may no longer need hospice care. You always have the right to stop hospice care at any time. If you choose to stop hospice care, your hospice provider will ask you to sign a form that includes the date your care will end.

No one should ask you to sign any forms about stopping your hospice care if you didn’t ask for them. Stopping hospice care is a choice only you can make, and you shouldn’t sign or date any forms until the actual date you want your hospice care to stop.

If you were in Original Medicare when you decided to stop hospice care, you can continue in Original Medicare. If you’re eligible, you can go back to hospice care at any time.

If you were in a Medicare Advantage Plan when you started hospice, you can stay in that plan while getting hospice care as long as you continue to pay your plan’s premiums. If you’ve been paying your plan’s premiums, you can continue to get Medicare coverage from your plan after you stop hospice care. Go to page 7 for more information.

Rights and Protections

Protect yourself from fraud

Medicare fraud can happen anywhere. It’s important that you protect your Medicare information and decline services you don’t need. People with Medicare should avoid scammers who offer services that aren’t provided by your hospice team. Some scammers will try to get you to sign up for hospice even if you don’t need it.

To help protect yourself from fraud, remember these tips:

• Your doctor is the only one who can certify you’re terminally ill (with a life expectancy of 6 months or less). If you aren’t terminally ill, you shouldn’t get hospice care.
• Never accept perks or gifts for signing up for hospice services.
• Medicare won’t provide “free” services like housekeeping.
• Don’t share your Medicare Number if someone offers you free services like housekeeping or cooking.

To learn more about how to identify and report fraud, visit Medicare.gov/fraud. To report potential fraud, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Your Medicare rights

As a person with Medicare, you have guaranteed rights, including:

• The right to get care that meets professionally recognized standards. If you believe the care you’re getting is below this standard, and you’re dissatisfied with the way your hospice provider has responded to your concern, you have the right to contact a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). The BFCC-QIO is administered for Medicare by Livanta or Acentra depending on what state you live in. Check their websites to make sure you’re contacting the right organization for your state.
• The right to ask for a review of your case. If your hospice provider or doctor believes you’re no longer eligible for hospice care because your condition has improved, but you don’t agree, you have the right to ask for a review of your case. Your hospice provider should give you a notice that explains your right to an expedited (fast) review by a BFCC-QIO. If you don’t get this notice, ask for it. This notice lists your BFCC-QIO’s contact information and explains your rights.

To see a full list of your rights, visit Medicare.gov/basics/your-medicare-rights, or call 1-800-MEDICARE.

How to submit a quality of care complaint

If you or your caregiver has a complaint about the quality of care you or someone you care for got in a health care facility, you can file a complaint with your state’s survey agency.

• For a list of agency addresses and phone numbers, visit CMS.gov/medicare/ health-safety-standards/quality-safety-oversight-general-information/contact-information.
• If you’re uncomfortable filing a complaint with your hospice provider, or if you’re dissatisfied with how your hospice provider has responded to your complaint, you can file a complaint with your BFCC-QIO by visiting Livanta or Acentra or calling 1-800-MEDICARE.

For more information

To learn more about Medicare eligibility, coverage, and costs and get official Medicare publications and resources, visit Medicare.gov or call 1-800-MEDICARE.

For more information about hospice, contact these organizations:

• The National Alliance for Care at Home Visit allianceforcareathome.org, or call 1-800-646-6460.
• Family Caregiver Alliance Visit www.caregiver.org, or call 1-800-445-8106.
• Hospice Foundation of America Visit hospicefoundation.org, or call 1-800-854-3402.

Definitions

Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)—A type of QIO (an organization of doctors and other health care experts under contract with Medicare) that uses doctors and other health care experts to review complaints and quality of care for people with Medicare. The BFCC-QIO makes sure there is consistency in the case review process while taking into consideration local factors and local needs, including general quality of care and medical necessity.

Coinsurance—An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Copayment—An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.

Deductible—The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Medicare Advantage Plan (Part C)—A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits, with a few exclusions, for example, certain aspects of clinical trials which are covered by Original Medicare even though you’re still in the plan. Medicare Advantage Plans include:

• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

• Most Medicare services are covered through the plan
• Most Medicare services aren’t paid for by Original Medicare
• Most Medicare Advantage Plans offer prescription drug coverage

Medicare health plan—Plans offered by private companies that contract with Medicare to provide Part A, Part B, and in many cases, Part D benefits. Includes Medicare Advantage Plans and certain other types of coverage (like Medicare Cost Plans, PACE programs, and demonstration/pilot programs).

Medicare Part A (Hospital Insurance)—Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)—Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medigap policy—Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage.

Original Medicare—A Fee-for-Service health insurance program that has 2 parts: Part A (Hospital Insurance) and Part B (Medical Insurance). You typically pay a portion of the costs for covered services as you get them. Under Original Medicare, you don’t have coverage through a Medicare Advantage Plan or another type of Medicare health plan.

Premium—The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Source and further reading

Medicare Hospice Benefits — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.