The Medicare hospice benefit covers nearly all costs related to comfort care for a terminal illness, including nursing, medications for symptom relief, medical equipment, counseling, and support for your family. It falls under Medicare Part A and pays for these services with little to no out-of-pocket cost to you. To qualify, a doctor must certify that your life expectancy is six months or less if the illness follows its normal course.
How Eligibility Works
You become eligible for the hospice benefit when two conditions are met: you have Medicare Part A, and a physician certifies that your terminal illness carries a life expectancy of six months or less. This certification can come from the hospice program’s medical director or, if the medical director is unavailable, a designated physician within the hospice. Your own doctor can also be involved in the certification.
Electing hospice means you’re choosing comfort-focused care rather than treatments aimed at curing your terminal condition. You can change your mind and leave hospice at any time to resume curative treatment, and you can re-enroll later if you choose. The benefit isn’t limited to a single six-month window. It’s structured in benefit periods: two initial 90-day periods, followed by an unlimited number of 60-day periods. Before each new period, a physician must recertify that you still meet the six-month prognosis. People sometimes stay on hospice for well over a year if they continue to qualify at each recertification.
Services Covered at No Cost to You
The hospice benefit is broad. It pays for a team of professionals and a wide range of services related to your terminal diagnosis, typically at no charge. Here’s what’s included:
- Nursing care: Registered nurses and licensed practical nurses visit your home on a regular schedule and are available for urgent needs.
- Physician services: Medical oversight from the hospice medical director and, in many cases, coordination with your personal doctor.
- Medications for comfort: Prescription drugs related to pain relief and symptom management for your terminal illness. You may pay a small copayment of $5 or less per prescription for these medications.
- Medical equipment and supplies: Hospital beds, wheelchairs, oxygen equipment, wound care supplies, catheters, and similar items needed for your care at home.
- Hospice aide and homemaker services: Personal care assistance like bathing, light housekeeping, and meal preparation.
- Physical, occupational, and speech therapy: These are provided when they help manage symptoms or maintain comfort, not for rehabilitation.
- Social work services: A social worker helps with practical concerns like advance directives, financial questions, and family dynamics.
- Dietary counseling: Guidance on nutrition as it relates to comfort and quality of life.
- Spiritual care: Chaplains or spiritual counselors are part of the hospice team, available regardless of your religious background.
- Grief and bereavement support: Counseling for your family members and caregivers, available for up to one year after death.
All of these services are coordinated through your hospice provider as part of an individualized care plan developed by an interdisciplinary team.
Four Levels of Hospice Care
Medicare defines four distinct levels of care, each designed for different situations. Most people receive the first level for the majority of their time on hospice.
Routine home care is the standard level. You receive hospice services wherever you live, whether that’s your own house, an assisted living facility, or a nursing home. Nurses, aides, and other team members visit on a scheduled basis, and you call the hospice for help between visits. This is what hospice looks like on a typical day when symptoms are under control.
Continuous home care kicks in during a crisis. If you develop severe pain, uncontrolled nausea, acute breathing difficulty, or another urgent symptom, the hospice provides nursing care on a near-continuous basis in your home. The goal is to get the crisis under control so you can remain at home rather than being transferred to a facility. This level is only available during brief crisis periods.
General inpatient care is for symptoms that simply can’t be managed at home. You’re admitted to a hospital, hospice inpatient unit, or skilled nursing facility for short-term pain control or acute symptom management. Once symptoms stabilize, you return to routine home care.
Inpatient respite care exists specifically to give your caregiver a break. You stay in an approved facility for up to five consecutive days. Medicare covers this with a small copayment, roughly 5% of the Medicare-approved rate for each day.
What’s Not Covered
Once you elect hospice, Medicare stops paying for treatments intended to cure your terminal illness. If you have cancer and choose hospice, for example, chemotherapy aimed at shrinking the tumor would no longer be covered. However, if that same chemotherapy were being used purely for pain relief or symptom control, it could still qualify.
Medicare also does not cover room and board. If you live in a nursing home or assisted living facility, you or another insurance source still pay the facility’s daily rate. The hospice benefit covers the hospice services delivered in that facility, but not the cost of living there. The exception is during general inpatient care or respite care, where the facility stay itself is part of the benefit.
Any treatment for a condition unrelated to your terminal diagnosis remains covered under regular Medicare. If you break your arm or need care for diabetes that isn’t connected to your hospice diagnosis, Medicare Parts A and B still pay for that care as they normally would. You simply need to make sure your hospice provider knows about it so the billing is handled correctly.
Bereavement Support for Families
One of the less widely known parts of the benefit is what it provides after a patient dies. Hospice programs are required to offer bereavement counseling to family members and other individuals identified in the care plan for up to one year following the death. This can include individual counseling, support groups, phone check-ins, and referrals to community resources. The counseling addresses grief, loss, and adjustment, and it’s available at no additional charge. Many families find this support valuable in the months immediately after a loss, when the structured presence of the hospice team suddenly ends.
Out-of-Pocket Costs
For most hospice services, you pay nothing. Medicare covers the full cost of nursing, equipment, supplies, counseling, and home visits. The two exceptions are modest. Prescription drugs for pain and symptom management may carry a copayment of up to $5 per medication. Inpatient respite care requires a copayment equal to about 5% of the Medicare-approved amount for each respite day.
There is a cap on what Medicare will pay a hospice provider per patient in a given year. For fiscal year 2025, that cap is $34,465.34, up from $33,494.01 in 2024. This cap applies to the hospice agency, not to you directly. If your care costs approach the cap, the hospice program absorbs the financial risk. You won’t receive a bill for exceeding it.
How Hospice Interacts With Other Medicare Coverage
Electing hospice doesn’t cancel the rest of your Medicare. Part B continues to cover doctor visits and services for conditions unrelated to your terminal diagnosis. If you have a Medicare Advantage plan, your hospice care is still paid by original Medicare Part A, not by the Advantage plan. The Advantage plan continues covering non-hospice services.
Medications unrelated to your terminal illness remain covered under Medicare Part D. Only drugs directly related to your hospice diagnosis shift to the hospice benefit. Your hospice team will clarify which medications fall under which coverage so you’re not caught off guard at the pharmacy.