What Is the Medicare Hospice Benefit and What Does It Cover?
By CRYSTAL BAI •
The short answer: The Medicare Hospice Benefit (Part A) covers comprehensive comfort-focused care for Medicare beneficiaries with a terminal prognosis of six months or less if the illness runs its normal course. It covers virtually all hospice-related services at little to no cost, including medications, equipment, nursing, aide services, social work, chaplaincy, and bereavement support for family.
Who Qualifies for the Medicare Hospice Benefit
To qualify, a patient must: (1) be enrolled in Medicare Part A, (2) have a terminal illness with a life expectancy of six months or less as certified by two physicians, and (3) choose comfort care over curative treatment for the terminal diagnosis. Electing hospice does not mean giving up all medical care — treatment for unrelated conditions continues.
What Medicare Hospice Covers
- Nursing visits — regular visits from a registered nurse; increased frequency as death approaches
- Physician services — hospice medical director oversight; attending physician coordination
- Home health aide services — bathing, grooming, personal care
- Medical social work — family counseling, resource coordination, advance care planning support
- Chaplaincy and spiritual care — non-denominational spiritual support for patient and family
- Medications related to the terminal diagnosis — pain management, symptom control drugs (small copay may apply)
- Durable medical equipment — hospital bed, wheelchair, bedside commode, oxygen
- Continuous home care — intensive nursing during medical crises (up to 24 hrs/day)
- Inpatient respite care — up to 5 consecutive days in a facility to give caregivers a break
- General inpatient care — facility-based care for uncontrolled symptoms
- Bereavement counseling — at least 13 months of support for family after death
What Medicare Hospice Does NOT Cover
Hospice does not cover: curative treatment for the terminal diagnosis, room and board in a nursing home or assisted living (though hospice services are delivered there), emergency room visits or hospitalizations for the terminal diagnosis (unless authorized), or treatment for unrelated acute conditions requiring hospitalization.
Hospice Benefit Periods
The hospice benefit is organized in 90-day and 60-day periods. After each period, a hospice physician recertifies that the patient still qualifies (prognosis still ≤6 months). There is no lifetime limit on hospice benefit periods — a patient can remain on hospice indefinitely if they continue to qualify.
Can You Leave Hospice?
Yes. Patients can revoke the hospice election at any time and return to standard Medicare coverage. They can also re-elect hospice later if they again meet eligibility criteria.
Frequently Asked Questions
Does Medicare cover hospice in a nursing home?
Yes — Medicare hospice covers the hospice services (nursing, medications, equipment, etc.) in a nursing home, but does not cover the room and board. Medicaid or private pay typically covers room and board.
Is there a cost for Medicare hospice?
Very little. Medicare covers nearly all hospice costs. Patients may pay a small copay (up to $5) for each prescription drug and 5% of the Medicare-approved amount for inpatient respite care.
What if my prognosis improves on hospice?
If a patient's condition stabilizes or improves, the hospice team will discuss whether they still qualify. Patients can graduate from hospice — returning to standard Medicare — and re-elect later.
Can I keep my own doctor on hospice?
Yes. Your attending physician can remain part of your care team and bill Medicare separately for visits. The hospice medical director coordinates with your doctor.
Does Medicare cover a death doula?
Medicare does not currently cover death doula services. However, death doulas can work alongside the hospice team to provide additional emotional, logistical, and legacy support that hospice may not fully provide.
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