Anyone can start the hospice enrollment process, either by asking a doctor for a referral or by calling a hospice provider directly. You do not need a physician’s permission to make that first call. The process typically moves quickly, often within days, because hospice agencies understand that families reaching this point need support soon.
Who Is Eligible for Hospice
Hospice care is available to people with a terminal illness and a life expectancy of six months or less if the disease follows its expected course. Two physicians must certify this prognosis: the hospice’s own medical director and the patient’s regular doctor (if they have one). The certification is based on clinical judgment, not a guarantee. Many people live longer than six months on hospice, and care simply continues with periodic recertification.
The other key requirement is that the patient agrees to shift the goal of care from curing the illness to managing symptoms, pain, and quality of life. This means signing a statement choosing hospice in place of curative treatments for the terminal diagnosis. You can still receive full medical treatment for any unrelated health conditions.
Two Ways to Start the Process
The most common path is asking the patient’s physician for a hospice referral. If the doctor agrees the illness has reached a point where comfort-focused care makes sense, they’ll connect you with a hospice agency or help you choose one. Many hospitals and oncology practices have staff who coordinate this transition.
If the physician doesn’t bring up hospice, or doesn’t agree it’s the right time, you can bypass that step entirely. Contact a hospice provider on your own. This is called a self-referral, and hospice agencies handle them routinely. You can find local providers through Medicare’s Care Compare tool at Medicare.gov, which publishes quality ratings and patient experience survey results for hospice agencies across the country. Searching by zip code will show you every Medicare-certified hospice in your area along with data on how families rated their care.
What Happens After You Make Contact
Once you reach a hospice provider, ask for a no-cost, no-obligation evaluation visit. A hospice team member will come to wherever the patient is, whether that’s a private home, hospital room, nursing home, or assisted living facility. During this visit, they assess the patient’s condition, explain what services the agency provides, and answer questions about how day-to-day care would work.
If the patient is eligible and wants to proceed, the formal enrollment involves signing an election statement. This document confirms the patient understands they’re choosing hospice care and that curative treatments for the terminal illness will be replaced by comfort-focused care. The hospice agency handles the physician certification paperwork. In most cases, the agency can obtain the necessary medical certifications and begin providing care within a few days. If the written certification can’t be completed immediately, an oral certification from the physicians within two calendar days keeps things moving.
What Hospice Covers and What It Costs
For people on Medicare, the hospice benefit covers nearly everything related to the terminal illness at no cost to the patient. That includes visits from nurses, doctors, home health aides, social workers, chaplains, and counselors. It also covers all prescription medications for pain relief and symptom control, all durable medical equipment like hospital beds, wheelchairs, and oxygen equipment, plus medical supplies such as bandages and catheters. The hospice agency pays for all of this directly.
The only out-of-pocket costs under Medicare are small. You may pay a copayment of up to $5 for each prescription drug related to symptom management while you’re at home. There’s also a 5% copay if you need short-term inpatient respite care (temporary stays that give your caregiver a break). That’s it. There are no deductibles for hospice under Medicare.
Medicaid covers hospice in most states as an optional benefit, and it works similarly. The patient elects hospice, acknowledges the shift away from curative treatment, and receives comfort-focused services. One important difference: children and young adults under 21 on Medicaid or CHIP do not have to give up curative treatment. They can receive both curative care and hospice care at the same time. Most private insurance plans also include a hospice benefit, though the specifics vary by plan.
Choosing the Right Hospice Provider
Not all hospice agencies deliver the same level of care. When comparing providers, start with Medicare’s Care Compare website, which reports quality measures based on data hospices are required to submit. These include clinical measures drawn from patient records and results from the CAHPS survey, a standardized questionnaire that asks families about their experience with communication, timely help, and emotional support.
Beyond the ratings, ask practical questions during the evaluation visit. Find out how quickly a nurse can reach the patient’s home in an emergency, whether the agency provides 24-hour phone support, what happens on weekends and holidays, and how often a nurse or aide will visit during a typical week. Ask whether the agency has experience with the patient’s specific diagnosis. A hospice that primarily serves cancer patients may approach care differently than one experienced with heart failure or dementia.
If you’re considering more than one provider, request evaluation visits from each. There’s no rule limiting you to one, and the visits are free. Comparing how different teams communicate and what they offer can make the decision much clearer.
You Can Leave Hospice at Any Time
Enrolling in hospice is not a permanent decision. A patient (or their representative) can revoke the hospice election at any point by submitting a signed statement to the hospice agency that includes the date the revocation takes effect. Once revoked, standard Medicare or insurance benefits resume, and the patient can pursue curative treatment again. People sometimes leave hospice because their condition stabilizes or improves, or because a new treatment option becomes available.
You can also re-enroll in hospice later if circumstances change. There is no limit on the number of times a person can elect and revoke the hospice benefit. The flexibility is built into the system specifically so that choosing hospice doesn’t feel like closing a door.
When to Start the Conversation
Many families wait longer than they wish they had. National data consistently shows that a significant number of hospice patients enroll in the final days of life, which limits the support the team can provide. Hospice is designed to serve patients for weeks or months, not just the very end. Earlier enrollment means more time for the care team to manage pain effectively, support the family emotionally, and help the patient live as comfortably as possible. If the question of hospice has crossed your mind, that’s a reasonable time to make the call and schedule an evaluation.