You can start hospice care in one of two ways: ask a treating physician for a referral, or contact a hospice provider directly. No doctor’s order is needed to make that first call. Once you reach out, a hospice team member will visit the patient at no cost and with no obligation to assess eligibility, answer questions, and, if the patient agrees, begin care the same day paperwork is signed.
Who Qualifies for Hospice Care
Hospice is designed for people with a terminal illness whose life expectancy is six months or less if the disease follows its expected course. Two physicians must certify this prognosis: the hospice’s medical director and the patient’s own doctor (if they have one). That certification doesn’t mean anyone is predicting death within six months. It means that, based on the trajectory of the illness, the medical team believes curative treatment is no longer likely to help and comfort-focused care is the better path.
For cancer, the determination is often straightforward based on tumor progression and declining function. For other illnesses, specific clinical benchmarks guide the decision. A person with advanced dementia typically qualifies when they can no longer walk, dress, or bathe without help, have lost meaningful verbal communication (six or fewer intelligible words), and experience incontinence. Someone with heart failure qualifies when symptoms are present even at rest and any physical activity increases discomfort. Stroke patients generally need to have lost the ability to perform most daily activities independently. Across all diagnoses, a baseline requirement is that the patient’s overall functional ability has declined to the point where they need substantial help with everyday tasks.
How to Start the Process
The most common route is to ask the patient’s primary care doctor, oncologist, or specialist to make a hospice referral. But you don’t have to wait for a doctor to bring it up. Anyone, including the patient, a family member, or a friend, can call a hospice provider and request an evaluation. This is called a self-referral, and every hospice accepts them.
Here’s what happens next:
- Initial visit. A hospice team member comes to wherever the patient is living, whether that’s a private home, hospital, nursing facility, or assisted living community. This visit is free and carries no commitment. The team member evaluates the patient’s condition, explains what hospice provides, and answers questions about what day-to-day care would look like.
- Choosing a provider. You can request evaluation visits from more than one hospice before deciding. Medicare’s Care Compare tool on Medicare.gov publishes quality ratings for hospice providers, including scores from patient and family experience surveys. Comparing a few options is worth the effort.
- Consent and admission. Once you’ve chosen a provider, the patient (or someone legally authorized to act on their behalf) signs consent forms electing hospice care. This can happen during the assessment visit itself. Care can begin immediately after the paperwork is complete.
- Care plan development. During an initial meeting at the patient’s residence, the hospice team creates a personalized care plan addressing pain management, symptom control, emotional support, and practical needs.
The physician certification of terminal illness must be obtained within two calendar days of care starting, so the hospice coordinates that documentation behind the scenes. You don’t need to have it in hand before services begin.
What the Hospice Team Provides
Medicare requires every hospice to maintain a core team that includes a physician, a registered nurse, a social worker or mental health counselor, and a pastoral or spiritual counselor. In practice, most programs also provide home health aides for personal care, trained volunteers for companionship, and access to physical or occupational therapists when needed.
The nurse becomes the primary point of contact, making regular home visits to manage symptoms like pain, nausea, shortness of breath, and anxiety. The social worker helps with family dynamics, advance directives, and connecting to community resources. Spiritual care is available regardless of religious background and is entirely optional. The team also supports the family, not just the patient, including grief counseling that extends after death.
Four Levels of Hospice Care
Not all hospice care looks the same. Medicare defines four distinct levels, and patients can move between them as needs change.
- Routine home care is the most common level. The patient is relatively stable, symptoms are under control, and care is provided at home with regular nurse visits and on-call support around the clock.
- Continuous home care kicks in during a crisis, such as uncontrolled pain or severe breathing difficulty. A nurse or aide stays in the home for extended hours (at least eight hours in a 24-hour period) until the crisis resolves.
- General inpatient care also addresses symptom crises but takes place in a hospital, hospice facility, or skilled nursing facility when symptoms can’t be managed at home.
- Respite care is the only level tied to caregiver needs rather than patient symptoms. The patient stays temporarily in a facility for up to five days so the person providing daily care at home can rest.
What It Costs
For anyone with Medicare Part A, hospice care is essentially free when provided by a Medicare-approved hospice. You pay nothing for nurse visits, aide services, medical equipment, or supplies related to the terminal illness. The only out-of-pocket costs are a copayment of up to $5 per prescription for pain and symptom medications, and 5% of the Medicare-approved rate for inpatient respite care. Most Medicaid programs cover hospice with similar or even lower cost-sharing. Private insurance plans vary, but the majority include a hospice benefit modeled on Medicare’s structure.
One important detail: when you elect hospice, you’re agreeing to shift the focus of care from curing the terminal illness to managing comfort. Medicare will still cover treatment for conditions unrelated to the terminal diagnosis, but it stops covering curative treatments aimed at the terminal illness itself.
How Benefit Periods Work
Hospice coverage under Medicare is organized into benefit periods. The first two periods last 90 days each. After that, coverage continues in unlimited 60-day periods for as long as the patient still qualifies. Before each new period begins, a hospice physician must recertify that the patient’s condition remains terminal. These recertifications can be completed up to 15 days before the next period starts, so there’s no gap in care.
If a patient stabilizes or improves, which does happen, the hospice may determine they no longer meet the criteria and discharge them. That person can re-enroll later if their condition worsens again.
You Can Change Your Mind
Electing hospice is not a one-way door. A patient or their authorized representative can revoke hospice care at any time by signing a short written statement with the hospice that includes the date the revocation takes effect. Once revoked, standard Medicare coverage resumes immediately, including coverage for curative treatments. The patient can re-elect hospice later if circumstances change.
This flexibility matters. Some families hesitate to start hospice because they fear it means “giving up.” In reality, hospice is a medical decision that can be reversed. Starting it does not prevent you from pursuing other options down the road.
Practical Tips for Getting Started
If you’re considering hospice for a loved one, the single most useful step is to call a local hospice provider and ask for an informational visit. You don’t need a referral, a diagnosis on paper, or certainty that it’s the right time. The evaluation is free, and many families find that simply having the conversation relieves enormous pressure.
When comparing providers, ask how quickly they can respond to after-hours emergencies, what their nurse-to-patient ratio looks like, and whether they offer specialized programs for conditions like dementia or heart failure. Check their quality scores on Medicare’s Care Compare website. Ask about volunteer availability, because families consistently say that having an extra person in the home, even for a few hours a week, makes a meaningful difference.
Timing is the most common regret families express. Studies consistently find that people who enroll in hospice earlier report better quality of life and that their families feel more supported. If the question of hospice has crossed your mind, it’s worth making the call.