You can sign up for hospice care in two ways: ask your doctor for a referral, or contact a hospice provider directly. No single gatekeeper controls access. The process typically moves quickly, often with care beginning within days of the first phone call, because families usually reach this point when comfort and quality of life have become the priority.
Who Is Eligible for Hospice
Hospice care is available to anyone with a terminal illness and a life expectancy of six months or less, as certified by two physicians. One is the hospice’s own medical director, and the other is the patient’s regular doctor (if they have one). The six-month timeframe doesn’t mean care stops after six months. If the illness continues its course, the hospice doctor can recertify eligibility after a face-to-face visit, and care continues for as long as the patient qualifies.
The other key requirement is that the patient agrees to focus on comfort care rather than treatments aimed at curing the terminal illness. This is a formal choice: you sign an election statement that shifts your Medicare coverage from curative treatment for that specific illness to hospice services. Importantly, this only applies to the terminal diagnosis. Treatments for other health conditions, like managing diabetes or heart failure, typically continue.
Two Ways to Start the Process
The most common path is through the patient’s own doctor. If you or a loved one are considering hospice, bring it up at an appointment or call the office directly. The doctor can confirm whether the illness has reached a point where hospice is appropriate and then refer you to a hospice provider they trust. You can also ask for a list of providers in your area so you can compare options.
The second path is a self-referral. Anyone, including the patient, a family member, or a friend, can call a hospice agency and ask about enrollment. You don’t need a doctor’s referral in hand to make that first call. The hospice will then coordinate with the patient’s physician to obtain the necessary medical certification.
What Happens After You Make Contact
Once you’ve reached out, the hospice provider will schedule a no-cost, no-obligation assessment visit. A member of the hospice team, usually a nurse, comes to wherever the patient is: home, hospital, nursing home, or assisted living facility. During this visit, they evaluate the patient’s condition to confirm eligibility, explain exactly what services the hospice offers, and answer questions from both the patient and family.
If everyone decides to move forward, the patient (or their healthcare proxy) signs an election statement. This document formally enrolls the patient in hospice and acknowledges the shift from curative treatment to comfort-focused care for the terminal illness. It also specifies which hospice provider will coordinate care going forward. After that paperwork is complete, the hospice team builds a care plan and services can begin, often within 24 to 48 hours.
What Hospice Actually Covers
Medicare’s hospice benefit is one of the most comprehensive coverage packages in the program, and it comes with almost no out-of-pocket cost. There is no deductible. Medicare pays the hospice provider directly for all services related to the terminal illness. This includes:
- Nursing visits and doctor services for symptom management
- Prescription drugs for pain and symptom control (you pay up to $5 per prescription)
- Medical equipment like hospital beds, wheelchairs, and walkers
- Medical supplies such as bandages and catheters
- Home health aide and homemaker services
- Physical, occupational, and speech therapy
- Social worker services and dietary counseling
- Grief and loss counseling for both the patient and family
- Short-term inpatient care when symptoms spike beyond what can be managed at home
- Respite care so family caregivers can take a break
What hospice does not cover: room and board (unless you need short-term inpatient or respite care arranged by the hospice team), treatments for conditions unrelated to the terminal illness that the hospice team didn’t arrange, and prescription drugs that aren’t related to the terminal diagnosis. Those unrelated prescriptions may still be covered under Medicare Part D.
Most private insurance plans and Medicaid also offer hospice benefits with similar coverage, though the specifics vary by plan.
How Medications Change
One of the biggest concerns families have is what happens to the patient’s medications. When you enroll in hospice, treatments aimed at curing the terminal illness stop. For a cancer patient, that means no more chemotherapy. For someone with end-stage organ failure, it means no more aggressive interventions to reverse the disease.
But medications that manage symptoms or treat other conditions generally continue. Pain medications, anti-nausea drugs, anxiety medications, antibiotics for infections, oxygen for breathlessness, and drugs for coexisting conditions like COPD or heart failure all remain part of the care plan. The hospice team works with the patient’s doctor to review every medication and keep what contributes to comfort and quality of life.
The Four Levels of Hospice Care
Hospice isn’t one-size-fits-all. Medicare defines four levels of care, and the hospice team adjusts based on what the patient needs at any given time.
Routine home care is by far the most common. The patient’s symptoms are reasonably controlled, and a hospice nurse, aide, or social worker visits on a regular schedule. Most hospice patients spend the majority of their time at this level, in their own home or a family member’s home.
Continuous home care kicks in during a crisis, like uncontrolled pain or severe breathing difficulty, that can still be managed at home. A nurse stays in the home for extended hours (at least eight hours in a 24-hour period) to stabilize the situation.
General inpatient care is for the same kind of crisis, but when it requires the resources of a hospital, hospice facility, or skilled nursing facility. Once symptoms are back under control, the patient returns home.
Respite care is the only level that exists for the caregiver’s benefit rather than the patient’s. The patient stays in a facility for up to five days so the primary caregiver can rest. You pay 5% of the Medicare-approved rate, which works out to roughly $5 a day.
How to Choose a Hospice Provider
Not all hospice agencies deliver the same quality of care, and you have the right to choose your provider. Medicare’s Care Compare tool (medicare.gov/care-compare) lets you search hospice agencies by location and review quality data side by side.
A few metrics are worth paying attention to. The “Hospice Visits in Last Days of Life” measure shows what percentage of a hospice’s patients received in-person visits from a nurse or social worker on at least two of their final three days. This is one of the clearest signals of whether an agency shows up when it matters most. The Hospice Care Index tracks ten indicators across the full length of stay, including gaps in nursing visits, how often patients are discharged and then rehospitalized, and how much skilled nursing time patients actually receive.
Beyond the data, ask practical questions during that initial assessment visit. How quickly does the agency respond to after-hours calls? What is the nurse-to-patient ratio? Does the agency have its own inpatient facility, or does it contract with local hospitals for crisis care? Families who ask these questions upfront tend to have a much clearer picture of what day-to-day support will look like.
You Can Leave Hospice at Any Time
Signing up for hospice is not a permanent, irreversible decision. You can revoke your hospice election at any time by submitting a signed, dated statement to the hospice provider. The revocation takes effect on the date you specify (which can’t be earlier than the day you submit the form), and your regular Medicare coverage for curative treatment resumes immediately.
People revoke hospice for various reasons. Sometimes a patient’s condition improves unexpectedly, or the family decides to pursue a new treatment option. Whatever the reason, the door stays open in both directions. If you leave hospice and later decide to return, you can re-enroll for any remaining hospice benefit periods you’re eligible for. There’s no penalty and no waiting period.