Medicare will pay for hospice care for as long as you remain eligible, with no maximum time limit. Coverage is organized into benefit periods: two initial 90-day periods, followed by unlimited 60-day periods after that. As long as a physician certifies that your life expectancy is six months or less if the illness follows its normal course, Medicare will continue covering hospice services indefinitely.
How Benefit Periods Work
Medicare structures hospice coverage in segments called benefit periods. The first two periods last 90 days each. Every period after that lasts 60 days. There is no cap on how many 60-day periods you can receive, so a patient who remains eligible can stay on hospice for years.
At the start of each new benefit period, a physician must recertify that you are still terminally ill. For the first two periods, this is a paperwork review. Starting with the third benefit period, the rules tighten: a hospice physician or hospice nurse practitioner must conduct an in-person visit within 30 days before the recertification. That face-to-face encounter is required for every benefit period from the third one onward. The clinician must write a narrative explaining why your specific clinical situation supports a prognosis of six months or less. Standardized check-box language isn’t allowed.
What Medicare Covers
Once you elect hospice, Medicare pays your hospice provider a daily rate that covers nearly everything related to your terminal illness: nursing visits, aide services, medical equipment like hospital beds and oxygen, medications for symptom control and pain relief, social work, spiritual counseling, and bereavement support for your family. Short-term inpatient care is also covered when the hospice team determines you need it for symptom management that can’t be handled at home, or for respite care to give your caregivers a break.
Medicare does not cover room and board. If you receive hospice at home, this is a non-issue. But if you live in a nursing home, you or Medicaid would still need to pay the facility’s room and board charges. Medicare only picks up the hospice services themselves. The one exception is when the hospice arranges a short-term inpatient stay at a facility for acute symptom management or respite; in that case, the facility stay is covered.
The Aggregate Cap
While there’s no limit on how many benefit periods you can have, Medicare does place an annual spending cap on each hospice provider. For fiscal year 2025, that cap is $34,465.34 per patient. This is an average calculated across all of a hospice’s patients, not a hard limit applied to any one person. In practice, some patients cost more and some cost less, and the hospice absorbs the difference. You won’t receive a bill if your care exceeds this figure, but if a hospice consistently goes over its cap, it must repay Medicare the excess. This cap exists to prevent abuse by providers, not to cut off your care.
What Could End Your Coverage
Three things can end Medicare hospice coverage: your condition improves, you choose to leave, or the hospice discharges you.
If your health stabilizes or improves to the point where you no longer meet the terminal illness criteria, the hospice is required to discharge you. Before doing so, the hospice medical director must issue a written discharge order, and if you have a personal physician involved in your care, that doctor should be consulted. The hospice must also have a discharge planning process in place that includes family counseling, patient education, and arranging any services you’ll need after leaving hospice. Being discharged doesn’t mean you can never return. If your condition worsens again and a physician certifies a six-month prognosis, you can re-elect hospice at any time.
You also have the right to revoke your hospice benefit voluntarily. This must be done in writing (a verbal request doesn’t count). Your signed statement needs to include the date the revocation takes effect, and you can’t backdate it. Once you revoke, you return to regular Medicare coverage immediately. You can re-elect hospice later if you’re still eligible. The hospice cannot pressure you to revoke or revoke on your behalf.
Switching Hospice Providers
If you’re unhappy with your hospice provider, you can transfer to a different one. You’re allowed one transfer per benefit period. To make the switch, you file a written statement with both your current hospice and the new one, naming both providers and the date the change takes effect. The transition must be seamless, with no gap between providers. Even a single day without coverage turns the transfer into a discharge and readmission, which means you’d need to formally re-elect hospice with the new provider.
What You Pay Out of Pocket
Hospice is one of the most generous Medicare benefits in terms of cost-sharing. You pay nothing for most hospice services, including nursing care, equipment, and counseling. There are two small exceptions. For prescription drugs related to pain and symptom management, you may owe a copayment of no more than $5 per medication. For inpatient respite care (temporary stays to relieve your caregiver), you pay 5% of the Medicare-approved amount. Beyond those charges, and the room and board exclusion mentioned earlier, hospice care under Medicare is essentially free to the patient for as long as coverage continues.
How Long People Actually Stay
Despite the unlimited duration of the benefit, most people don’t use hospice for very long. The median length of stay in hospice in the United States is roughly two to three weeks, largely because many patients are referred late in their illness. On the other end of the spectrum, some patients with slowly progressing conditions like dementia or heart failure remain on hospice for a year or more. Both situations are covered, as long as the recertification requirements are met at each benefit period. The system is designed to accommodate the reality that predicting exactly when someone will die is inherently uncertain, and a patient who outlives a six-month prognosis hasn’t done anything wrong. They simply need continued recertification that their trajectory still points toward a terminal outcome.