Yes, Medicare covers hospice care through Part A when a person meets Medicare’s eligibility rules, chooses comfort-focused care instead of treatment intended to cure the terminal illness, and receives care from a Medicare-approved hospice provider. The benefit can support the patient and family at home, in a nursing facility, or in an inpatient hospice setting. This guide explains what Medicare hospice coverage includes, what it may not include, and which questions to ask before care begins.
What does Medicare hospice coverage include?
Medicare hospice coverage is a Part A benefit designed to manage symptoms and provide comfort when a person is terminally ill. Instead of paying for treatment intended to cure the terminal illness, the hospice benefit coordinates an interdisciplinary team around the patient’s comfort, dignity, and support needs.
When a person qualifies, the hospice team creates a plan of care with the patient and family. The plan can include services such as:
- Doctor and nursing services related to the terminal illness
- Medical equipment, such as a hospital bed or oxygen, when included in the plan of care
- Medical supplies related to the terminal illness
- Prescription drugs for pain and symptom management
- Physical, occupational, or speech-language therapy when part of the plan
- Short-term inpatient care when symptoms cannot be managed at home
- Short-term respite care for a caregiver
- Social work, counseling, spiritual care, and grief or bereavement support
The exact services depend on the patient’s needs and the plan of care. Medicare.gov explains that the hospice team should arrange covered services and tell the patient or family when a service falls outside the hospice benefit.
Who is eligible for hospice under Medicare?
To qualify for Medicare hospice care, a person generally must satisfy four conditions. The person must have Medicare Part A, and the hospice doctor and regular doctor, when applicable, must certify that the person is terminally ill with a life expectancy of six months or less if the illness follows its usual course.
The person must also sign a statement choosing hospice care instead of other Medicare-covered treatment intended to cure the terminal illness and related conditions. Hospice is a choice, and signing the election statement does not mean a person gives up every form of medical care. It does mean that the hospice benefit becomes the primary coverage for care related to the terminal illness.
Eligibility does not depend on a diagnosis alone. The hospice medical director and the person’s physician evaluate the illness and certify eligibility. If the person lives longer than six months, hospice can continue as long as the hospice medical director or hospice doctor recertifies that the person remains terminally ill. Medicare provides defined benefit periods rather than a single six-month deadline.
How long does Medicare pay for hospice care?
Medicare hospice coverage is divided into benefit periods. A person who qualifies can receive two 90-day periods, followed by an unlimited number of 60-day periods. At the end of each period, the hospice must recertify continued eligibility.
- First 90-day benefit period
- Second 90-day benefit period
- Unlimited 60-day benefit periods after the initial two periods, when eligibility is recertified
A person can change hospice providers once during each benefit period. A person can also revoke the hospice election and return to regular Medicare coverage. If hospice is elected again later, the person must complete a new election. Ask the hospice provider how a change, revocation, or re-election would affect the care plan and billing.
Where can Medicare hospice care be provided?
Medicare hospice care is commonly delivered in the patient’s home or in the facility where the patient lives. Depending on the patient’s condition and the hospice plan, care may also be delivered in an inpatient hospice facility, hospital, or nursing facility. The location can change as needs change.
| Care setting | How hospice may work there | Important question |
|---|---|---|
| Home | The hospice team visits the patient and coordinates the plan of care with family or caregivers. | Which visits, equipment, supplies, and after-hours support are included? |
| Nursing facility or assisted living setting | The hospice team provides hospice services while the facility continues its role in daily living support. | Who is responsible for room and board and facility charges? |
| Inpatient hospice facility | Short-term inpatient care may be used when symptoms need a level of care that cannot be provided at home. | Is the admission for routine, continuous, respite, or general inpatient care? |
| Hospital | A hospital stay related to the terminal illness should be arranged by the hospice team when inpatient care is needed. | Has the hospice team arranged the stay to prevent unexpected charges? |
Hospice care at home does not mean a nurse is present around the clock. Routine home hospice generally involves scheduled visits and access to the hospice team by phone. Continuous home care may be available for short periods during a crisis, when the hospice determines it is appropriate. Ask how quickly the team responds to urgent symptoms and who to call after regular office hours.
Does Medicare cover hospice care in a nursing home or facility?
Medicare can cover hospice services for a person who lives in a nursing home or another facility, but the hospice benefit generally does not pay the room-and-board charge. The facility may bill separately for housing, meals, and custodial services. The hospice provider should explain which services are covered by hospice and which costs remain the patient’s responsibility.
This distinction matters because families may assume that choosing hospice covers every charge at the place where care is delivered. Before signing an agreement, ask for a written explanation of room and board, facility fees, medications, equipment, transportation, and any services not arranged by the hospice provider.
What happens to other Medicare-covered treatment after hospice begins?
When a person elects hospice, Medicare generally does not cover treatment intended to cure the terminal illness or related conditions. Instead, the hospice benefit focuses on comfort and symptom management. The patient can still receive Medicare-covered care for health problems that are unrelated to the terminal illness, subject to the usual Medicare rules.
For example, an unrelated medical service may remain covered under Original Medicare if it is medically necessary and meets Medicare’s requirements. However, the hospice team should know about the service first. Care from a provider outside the hospice plan, emergency care, ambulance transportation, or hospital treatment related to the terminal illness may not be covered unless the hospice team arranges it or the care is unrelated.
Do not cancel appointments or stop medication without speaking with the patient’s physician and hospice team. The practical question is not whether a person can ever see another clinician. It is whether the service is related to the terminal illness, included in the plan of care, and properly arranged.
What does hospice cost with Medicare?
Medicare.gov states that a person pays nothing for hospice care as long as the care comes from a Medicare-approved hospice provider and is part of the hospice benefit. There are still possible costs and coverage boundaries to understand:
- Prescription drugs: There may be a small copayment for each outpatient prescription used for pain and symptom control, subject to Medicare rules.
- Inpatient respite care: The patient may pay 5% of the Medicare-approved amount for inpatient respite care.
- Room and board: Medicare generally does not pay room and board when hospice is provided at home or while a person lives in a nursing home or hospice facility.
- Unrelated services: Care not related to the terminal illness may be covered under other Medicare rules, but the patient may have deductibles, coinsurance, or other cost sharing.
- Non-approved providers: Services from a provider that is not part of the hospice arrangement may not be covered by the hospice benefit.
Costs can depend on the setting, the service, and whether the hospice provider arranged it. Ask for a contact who can explain billing before receiving care, especially for transportation, emergency treatment, facility charges, and medications.
How should a family choose a Medicare-approved hospice provider?
Medicare.gov recommends checking whether a hospice provider is Medicare-approved. Families should also compare the provider’s practical support, communication standards, and approach to care. A helpful conversation can cover:
- How the hospice evaluates eligibility and handles recertification
- Which clinicians visit, how often they visit, and how urgent calls are handled
- Which equipment, medications, and supplies are included
- Whether the provider offers inpatient, respite, and continuous home care when appropriate
- How the provider coordinates with the patient’s doctor, facility, and family caregivers
- Which services or charges fall outside the hospice benefit
- How the provider supports family members with counseling and bereavement resources
You can use Medicare’s official Care Compare tool to research providers and discuss options with the patient’s medical team. My Senior Health Plan can help explain Medicare coverage questions, but hospice eligibility and the clinical plan of care must be determined by the hospice and medical professionals.
Frequently asked questions about Medicare hospice coverage
Does Medicare cover hospice care at home?
Yes. Medicare usually covers hospice care at home when the patient qualifies, elects hospice, and receives care from a Medicare-approved provider. The benefit can include nursing visits, equipment, supplies, symptom-management medication, counseling, and other services in the plan of care. Routine home hospice is not the same as 24-hour daily nursing.
Does Medicare cover 24-hour in-home hospice care?
Medicare may cover continuous home care for a short period when the hospice determines that the patient is experiencing a crisis and needs more intensive support. It is not generally a benefit for permanent, round-the-clock caregiving. Ask the hospice how it defines a crisis, who provides the care, and what alternatives are available.
Is hospice covered by Medicare Part A or Part B?
Hospice is generally covered through Medicare Part A when the patient meets the eligibility requirements and chooses the hospice benefit. Part B may still apply to medically necessary care for conditions unrelated to the terminal illness, subject to Medicare rules. The hospice team should help coordinate care related to the terminal illness.
Does Medicare cover hospice room and board?
Generally, no. Medicare does not usually cover room and board when a person receives hospice care at home or lives in a nursing home or hospice facility. The facility may charge separately for housing and custodial services. Ask for a written estimate before care begins.
Can a person leave hospice and return later?
Yes. A person can revoke the hospice election and return to regular Medicare coverage. If the person later chooses hospice again, a new election is required and the person must still meet the eligibility rules. Speak with the hospice and physician before making a change.
What is the main Medicare hospice coverage takeaway?
Medicare covers hospice care through Part A for eligible patients who choose comfort-focused care and use a Medicare-approved hospice provider. The benefit can cover a broad team of services in the home or another care setting, but room and board, some medications, respite care, and unrelated services may involve separate rules or costs. Confirm the plan of care, provider approval, setting, and billing questions before services begin.
For general Medicare guidance, you can review My Senior Health Plan’s Medicare 101 guide or contact the team directly. For official benefit details, review Medicare’s hospice coverage page and the Medicare Hospice Benefits publication.
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