Applying for hospice care starts with a conversation, not paperwork. Anyone can request it: you, a family member, or a doctor. The process typically moves quickly, often within days, because the people who need hospice usually need it soon. Here’s how each step works, from the first phone call through enrollment.
Who Can Request Hospice Care
You don’t need a doctor’s referral to get the process started. You can call a hospice agency directly, and so can a family member, social worker, hospital discharge planner, or clergy member. That said, a physician’s involvement is required before care can officially begin. Two doctors must certify that the patient has a terminal illness with a life expectancy of six months or less if the disease follows its expected course. One of those doctors is typically the patient’s own physician; the other is the hospice program’s medical director.
This six-month estimate is not a hard deadline. If the patient lives longer than six months, hospice care can continue as long as a doctor recertifies that the illness remains terminal. People sometimes hesitate to pursue hospice because they worry it means “giving up” or locking into something irreversible. It isn’t. You can leave hospice at any time and return to curative treatment.
Starting the Process
The most common way families begin is by calling a hospice provider and asking for an evaluation. You can also ask the patient’s primary care doctor or specialist to make the referral. If the patient is currently in a hospital, the discharge planning team will often bring up hospice and coordinate the referral before the patient goes home.
Once you contact a hospice agency, they’ll schedule an initial assessment visit, usually at the patient’s home or wherever they’re currently staying. An interdisciplinary team evaluates the patient’s physical condition, pain levels, emotional and spiritual needs, medication use, and how close death may be. They also assess the family’s ability and willingness to provide day-to-day caregiving and begin a bereavement assessment to understand what kind of support the family will need. This comprehensive assessment must be completed within five days of the patient electing hospice care.
During this visit, expect the team to review every medication the patient takes, including over-the-counter drugs, herbal remedies, and supplements. They’re looking at drug interactions, side effects, and whether current medications are still effective or necessary. The goal is to build a care plan focused entirely on comfort.
What You’ll Sign
To formally enroll, the patient (or their representative) signs a hospice election statement. This document does more than just consent to care. It explains the nature of the Medicare hospice benefit, outlines any cost-sharing, and notes that once hospice begins, Medicare will no longer cover treatments aimed at curing the terminal illness. It also notifies you that you have the right to request a written list of any items, drugs, or services the hospice considers unrelated to the terminal illness, along with their reasoning.
If you disagree with any of those determinations, you can request immediate advocacy through Medicare’s quality improvement organization. Signing the election statement addendum only acknowledges that you received the information. It does not mean you agree with the hospice’s decisions about what is or isn’t related to the terminal diagnosis.
What Hospice Costs Under Medicare
If the patient has Medicare Part A, hospice care is essentially free. You pay nothing for the core services: nursing visits, aide visits, social work, chaplain support, medical equipment like hospital beds and oxygen, and supplies related to the terminal illness. Prescription drugs for pain and symptom management carry a copay of up to $5 each. If the patient needs short-term inpatient respite care so the primary caregiver can rest, you may pay 5% of the Medicare-approved amount for that stay.
What Medicare does not cover once hospice begins: any treatment intended to cure the terminal illness, prescription drugs aimed at curing (rather than managing symptoms of) the illness, and room and board. If the patient lives in a nursing home, the hospice benefit covers the hospice services but not the nursing home’s regular room and board charges. Medicaid, if the patient qualifies, often covers room and board in a nursing facility separately.
Medicaid also covers hospice in every state, though benefits and eligibility details vary. Each state sets its own rules about the required life expectancy for eligibility, so contact your state Medicaid agency if Medicare isn’t in the picture. Most private insurance plans include a hospice benefit modeled on Medicare’s, but coverage specifics differ by plan.
The Four Levels of Hospice Care
Hospice isn’t one-size-fits-all. Medicare defines four distinct levels, and the patient can move between them as needs change.
- Routine home care is the most common level. The patient is generally stable, symptoms like pain and nausea are under control, and care is provided at home through regular visits from nurses, aides, and other team members.
- Continuous home care kicks in during a crisis, when pain or other symptoms spiral out of control. A nurse or aide stays in the home for extended hours to manage the situation, sometimes around the clock, until the patient stabilizes.
- General inpatient care is also crisis-level care, but it happens in a hospital, skilled nursing facility, or dedicated hospice unit. It’s used when symptoms can’t be managed at home.
- Respite care is the only level based on the caregiver’s needs rather than the patient’s symptoms. The patient temporarily moves to a facility so the person caring for them at home can take a break. Medicare covers up to five consecutive days of respite care at a time.
How to Choose a Hospice Provider
Not all hospice agencies deliver the same quality of care. Medicare’s Care Compare tool (medicare.gov/care-compare) lets you look up and compare hospice providers in your area using several concrete metrics.
One of the most telling measures is how often hospice staff visit patients in their final days. Medicare tracks the percentage of patients who received in-person visits from a nurse or social worker on at least two of their last three days of life. A high score here means the agency shows up when it matters most, not just during the stable early weeks. The Hospice Care Index scores agencies on a scale of 0 to 10 across ten indicators, including whether there are gaps in nursing visits, whether patients experience disruptive transitions like being discharged and then rehospitalized, and how much skilled nursing time patients actually receive per day.
Family experience surveys are also available. These rate agencies on how well the team communicated with the family, how quickly help arrived when needed (including evenings and weekends), whether the patient was treated with dignity, and the quality of emotional and spiritual support provided during care and after the patient’s death. Look for agencies that score high on “getting timely help,” since a hospice that’s hard to reach at 2 a.m. on a Saturday will create real problems when a crisis hits.
Leaving or Changing Hospice
You can revoke the hospice election at any time by filing a signed, dated statement with the hospice agency indicating that you’re ending hospice coverage for the current benefit period. The revocation takes effect on the date you choose, though you can’t backdate it. Once you revoke, standard Medicare coverage resumes immediately for the benefits that were paused when hospice began, including curative treatments.
Revoking doesn’t burn a bridge. The patient can re-elect hospice care for any future benefit period they’re eligible for. You can also switch to a different hospice agency once per benefit period without revoking, if you’re unhappy with the care but still want hospice services. The process for switching is simpler: you sign a new election statement with the new agency, and they handle the transfer.