Getting hospice care starts with a conversation with your doctor or your loved one’s doctor about a terminal diagnosis, followed by a referral to a Medicare-certified hospice provider. The core requirement is that two physicians certify a life expectancy of six months or less if the illness runs its normal course. From there, the process moves quickly: most people can begin receiving hospice services within days of that referral.
Who Qualifies for Hospice
To qualify under Medicare (which covers the vast majority of hospice care in the U.S.), three conditions must be met. First, two doctors need to certify the terminal illness: your regular physician and the hospice program’s medical director. Second, the patient agrees to shift from curative treatment to comfort care, meaning Medicare will no longer cover treatments aimed at curing the terminal illness. Third, the patient or their representative signs an election statement formally choosing hospice.
The six-month prognosis doesn’t mean the patient has exactly six months to live. It means that, in the physician’s clinical judgment, the illness would likely lead to death within six months if it follows its typical progression. Many patients live longer than six months on hospice and can be recertified for additional periods. Others enroll for just days or weeks, which is common and often reflects families waiting too long to start the conversation.
For children under 21, the rules are different and more flexible. Pediatric patients can receive hospice care and continue curative treatment for the same illness at the same time. This “concurrent care” provision exists because the choice between comfort and cure is especially difficult for families with sick children, and federal law removes the requirement to choose one or the other.
How to Start the Process
The most common path begins with the patient’s primary care doctor, oncologist, or hospital care team raising the topic of hospice. But you don’t need to wait for a doctor to bring it up. You can ask directly, and you can also contact a hospice provider yourself to request an evaluation. Hospice agencies routinely send a nurse or counselor to assess the patient, often within 24 to 48 hours of a call.
If the patient is in the hospital, a case manager or social worker can coordinate the referral before discharge. If the patient is at home, the family can call a local hospice and describe the situation. The hospice will then coordinate with the patient’s physician to get the necessary certification.
Once both physicians have provided their certification (including a written narrative explaining the clinical basis for the six-month prognosis), the patient or their representative signs an election statement. This document identifies the specific hospice provider, names the attending physician, confirms the patient understands that care will focus on comfort rather than cure, and outlines what Medicare will and won’t cover going forward. The effective date of hospice care can be the same day the statement is signed or a later date, but not earlier.
What Hospice Actually Provides
Hospice is not a place. It’s a package of services that usually comes to wherever the patient lives, whether that’s their own home, an assisted living facility, or a nursing home. The hospice team typically includes nurses, aides, social workers, chaplains, and volunteers who visit on a regular schedule and are available by phone around the clock.
Medicare covers four distinct levels of hospice care depending on what the patient needs at any given time:
- Routine home care is the most common level. The patient is relatively stable, symptoms like pain and nausea are under control, and the hospice team visits regularly in the home.
- Continuous home care kicks in during a crisis, when pain or other symptoms spike and can’t be managed with the usual visit schedule. A nurse stays in the home for extended hours to stabilize the situation.
- General inpatient care is also for crisis-level symptoms, but it takes place in a hospital, skilled nursing facility, or dedicated hospice unit when the patient’s symptoms can’t be controlled at home.
- Respite care is temporary inpatient care (up to five days at a time) designed to give the family caregiver a break. This is the only level tied to the caregiver’s needs rather than the patient’s symptoms.
What It Costs
For Medicare beneficiaries, hospice care has almost no out-of-pocket cost. Medicare covers the hospice team’s visits, medications related to the terminal illness, medical equipment like hospital beds and oxygen, and supplies. The only costs a patient might see are a copayment of up to $5 per prescription for pain and symptom management drugs, and 5% of the Medicare-approved amount for inpatient respite care. There are no deductibles for hospice under Medicare.
Most private insurance plans and Medicaid programs also cover hospice, though the specifics vary by plan. If a patient doesn’t have insurance, many hospice organizations provide care on a sliding scale or at no cost, funded by donations and community support. It’s worth asking any hospice provider directly about financial options.
How to Choose a Hospice Provider
Not all hospice providers are the same. Medicare’s Care Compare website lets you look up and compare Medicare-certified hospice agencies in your area using quality data that every hospice is required to report. These quality measures track whether the hospice screens for and treats pain, addresses breathing difficulties, asks about the patient’s treatment preferences, and respects their beliefs and values.
Beyond the quality scores, there are practical questions worth asking any hospice you’re considering. How quickly can they start care? What’s their response time for after-hours calls? Do they have staff who specialize in your loved one’s specific illness? What does their volunteer program look like? How do they support the family after the patient dies? Some hospices offer more robust bereavement programs than others, and that support can matter enormously.
How Long Hospice Lasts
The initial hospice benefit covers two 90-day periods, followed by an unlimited number of 60-day periods after that. At the start of each new period, a hospice physician must recertify that the patient still has a life expectancy of six months or less. There is no maximum time limit on hospice care. As long as the patient continues to meet the criteria, benefits continue.
If the patient’s condition improves to the point where they no longer qualify as terminally ill, the hospice will begin discharge planning, which includes arranging for any follow-up care, family counseling, or other services the patient will need. This is sometimes called a “live discharge,” and it happens more often than people expect. The patient returns to regular Medicare coverage and can re-enroll in hospice later if the illness progresses again.
Leaving Hospice Voluntarily
A patient can leave hospice at any time for any reason. Perhaps they want to pursue a new treatment, or they simply change their mind. To do this, the patient or their representative must submit a written, signed statement to the hospice specifying the date the revocation takes effect. A verbal request is not enough; it must be in writing. Once hospice is revoked, regular Medicare benefits resume immediately, and the patient can re-elect hospice in a future benefit period if needed.
This flexibility is important to understand because it removes a common fear: choosing hospice does not mean giving up all options permanently. It’s a decision that can be reversed.