Types of Care
Hospice Care: Eligibility, Medicare Coverage and Where It Happens
What Is Hospice Care, and What Does Medicare Cover?
Hospice care is comfort-focused care for a person with a terminal illness whose doctors certify a life expectancy of 6 months or less if the illness runs its usual course. Medicare Part A pays for hospice in full apart from small copays, at home, in assisted living or in a nursing home, but it doesn't pay room and board. It also covers inpatient respite for the family, up to 5 days at a time.
Hospice is care for the last stretch of a serious illness, when the goal shifts from curing the disease to living as comfortably as possible. It treats pain and other symptoms, supports the family, and brings a team to wherever your parent lives. For many families it’s also the first time someone is on call around the clock to help.
People often wait too long to start it. The National Institute on Aging notes that some people begin hospice so close to the end that they miss much of the help it offers. This guide explains who qualifies, what Medicare covers and doesn’t, where hospice happens, and how to choose a provider.
What Hospice Care Is
Hospice is a kind of palliative care. NIA describes palliative care as care that improves quality of life for anyone with a serious illness, at any stage, and it can be given alongside treatment meant to cure the disease. Hospice is palliative care for a person whose doctor believes they have six months or less to live if the illness runs its natural course, and attempts to cure the illness stop.
Stopping curative treatment doesn’t mean stopping all treatment. NIA’s example: if chemotherapy is no longer working and a person with cancer chooses hospice, the chemotherapy ends, but medicine for high blood pressure continues as long as it helps.
| Question | Palliative care | Hospice care |
|---|---|---|
| Who can get it? | Anyone with a serious illness | Someone whose doctors expect 6 months or less to live |
| Can curative treatment continue? | Yes, if you wish | No, only comfort and symptom care |
| Does Medicare pay? | Depends on benefits and treatment plan | Yes, through the hospice benefit |
| Where? | Home, assisted living, nursing home, hospital, clinic | Home, assisted living, nursing home, hospice facility, hospital |
Source for the comparison: NIA, which adapted it from the National Hospice and Palliative Care Organization.
Who Qualifies for Hospice Under Medicare
Medicare.gov lists the conditions. Your parent must have Medicare Part A and:
- The hospice doctor and your parent’s regular doctor, if they have one, certify that your parent is terminally ill, with a life expectancy of 6 months or less.
- Your parent accepts comfort care instead of care to cure the illness.
- Your parent signs a statement choosing hospice instead of other Medicare-covered treatment for the terminal illness and related conditions.
Before deciding, your parent can get a one-time consultation with a hospice medical director or hospice doctor to talk through options and symptom control, even if they don’t choose hospice.
Hospice for a Person Living With Dementia
Medicare doesn’t keep a list of qualifying diagnoses. A person living with dementia qualifies the same way anyone else does: when the doctors certify a life expectancy of 6 months or less. NIA notes that doctors find it hard to predict how long an older, sick person will live, and health often declines slowly. If you think hospice might help, ask your parent’s doctor directly. If it’s too early for hospice, palliative care can still help with symptoms and planning. The dementia care options guide covers care across the course of the disease.
What Medicare Covers and What You Pay
Once hospice starts, Original Medicare covers everything your parent needs related to the terminal illness, from a Medicare-approved hospice. The hospice team builds a plan of care that can include:
- doctor and nursing services, with a hospice nurse and doctor on call 24 hours a day, 7 days a week;
- medical equipment, like a wheelchair or walker, and supplies;
- prescription drugs for pain and symptom control;
- hospice aide and homemaker services;
- physical, occupational and speech therapy;
- social work and dietary counseling;
- grief and loss counseling for your parent and family;
- short-term inpatient care for pain and symptoms;
- short-term respite care for the caregiver.
| What your parent pays | Amount |
|---|---|
| Covered hospice services | Nothing; no deductible |
| Outpatient drugs for pain and symptoms | Up to a $5 copay per prescription |
| Inpatient respite care | 5% of the Medicare-approved amount |
| Room and board at home, in assisted living or in a nursing home | Not covered by hospice |
| Care for unrelated health problems | Usual Medicare deductibles and coinsurance |
What Hospice Doesn’t Cover
Medicare’s hospice booklet lists the exclusions:
- treatment intended to cure the terminal illness;
- prescription drugs that aren’t for the terminal illness or related conditions (Part D may cover them);
- care from providers the hospice team didn’t arrange;
- room and board;
- hospital, emergency room or ambulance care for the terminal illness that the hospice team didn’t arrange.
That last point matters in a crisis. Call the hospice first. If your parent goes to the hospital without the hospice arranging it, Medicare’s booklet warns, your parent might owe the entire cost.
Where Hospice Care Happens
Hospice is an approach, not a place. Medicare covers it at home, in assisted living, in a nursing home or in an inpatient hospice facility.
- At home. Medicare’s booklet says hospice care is usually given at home. NIA is clear that day-to-day care is still provided by family and friends; the hospice team visits, coaches the family and is available by phone around the clock.
- In a nursing home or assisted living. The hospice team visits your parent there. Hospice doesn’t pay the facility’s room and board, so that bill continues (see how to pay for a nursing home): from your parent’s funds, Medicaid if your parent qualifies, or long-term care insurance. The nursing home finder shows CMS ratings for every certified home.
- In an inpatient facility. For short stays to control pain or symptoms, or for respite, the hospice arranges a stay in a hospice facility, hospital or nursing home, and Medicare covers it.
Levels of Hospice Care
Medicaid.gov names the four levels hospices bill for, which mirror Medicare’s:
- Routine home care: regular visits wherever your parent lives.
- Continuous home care: mostly nursing care at home during a short crisis.
- Inpatient respite care: a short facility stay to give the family caregiver a rest.
- General inpatient care: a short stay for pain or symptoms that can’t be managed elsewhere.
Hospice Respite Care for Family Caregivers
If you’re the main caregiver and need rest, the hospice can arrange inpatient respite for your parent in a Medicare-approved facility, such as a hospice inpatient facility, hospital or nursing home. Each stay can last up to 5 days, and respite can be used more than once, but only occasionally. Your parent pays 5% of the Medicare-approved amount; a Medigap policy covers that cost. The respite care guide explains other ways to get a break.
Caring for the Caregiver During Hospice
Hospice supports the family as well as the patient. Medicare’s benefit includes grief and loss counseling for your family, and social workers and counselors are part of the hospice team. Use them. They can help with hard conversations, practical planning and the strain of caring for someone at home.
A few things families often find useful:
- Ask the hospice nurse to teach you. NIA notes that the hospice team coaches family members on how to care for the person day to day. Ask them to show you anything you’re unsure about.
- Keep the hospice number by the phone. Call it first, day or night, before calling 911 or going to the hospital, unless someone is in immediate danger.
- Share the load. Ask relatives and friends for specific help, and look at the caregiver support programs guide for local help.
- Get the paperwork in order. Advance directives and a health care power of attorney make your parent’s wishes clear.
If you feel overwhelmed or hopeless, call or text 988 for the 988 Suicide and Crisis Lifeline, any time.
How Long Hospice Lasts and How to Stop
Medicare covers hospice in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. At the start of each period after the first, the hospice doctor recertifies that your parent is still terminally ill. Your parent doesn’t need to re-elect hospice each time and can change hospice providers once per benefit period.
Your parent can stop hospice at any time, for example if their health improves. Medicare is firm that this is your parent’s choice alone, and no one should ask them to sign forms to stop hospice if they didn’t ask. If your parent stops and later becomes eligible again, they can return.
Who Pays for Hospice Besides Medicare
- Medicaid. Hospice is an optional Medicaid benefit that covers similar services. Medicaid.gov says a person can revoke the hospice election at any time and get back the Medicaid services they waived.
- VA. VA provides hospice to enrolled Veterans with less than 6 months to live, at home, in outpatient clinics or in Community Living Centers, with no copays. See the VA long-term care guide.
- Medicare Advantage. Original Medicare pays for hospice even if your parent stays in a Medicare Advantage plan; the plan can still cover extra benefits.
- Private insurance. Coverage depends on the plan.
How to Choose a Hospice
Talk with your parent’s doctor and the hospital discharge planner. Medicare’s Care Compare lists Medicare-approved hospice providers and lets you compare them on quality. Medicare covers hospice only from a Medicare-approved provider. Questions worth asking:
| Ask | Why |
|---|---|
| How quickly can you start, and how often will the nurse visit? | Sets expectations for the first days |
| Who answers the phone at night, and how fast can a nurse come? | Crises often happen after hours |
| Do you provide continuous home care during a crisis? | Not every family knows to ask |
| How do you arrange inpatient respite, and where? | You may need a break |
| What grief support do you offer the family after a death? | Bereavement counseling is part of the benefit |
| Do you visit residents in my parent’s nursing home or assisted living? | Confirms the hospice works with that facility |
If your parent isn’t ready for hospice, the Care Options Guide can help you compare in-home care and other settings, and the legal and financial planning guide covers advance directives worth completing now.
Frequently Asked Questions
Is Dementia a Qualifying Diagnosis for Hospice?
Medicare doesn't use a list of qualifying diagnoses. A person living with dementia can get hospice when the hospice doctor and their regular doctor certify a life expectancy of 6 months or less if the illness runs its usual course. NIA notes that doctors have a hard time predicting how long an older, sick person will live, so ask the doctor directly whether your parent meets that standard now.
Can My Parent Leave Hospice and Come Back Later?
Yes. Medicare says your parent can stop hospice at any time, for example if their health improves, and go back to regular Medicare coverage. If they're eligible again later, they can return to hospice. No one should pressure your parent to sign forms to stop hospice; only your parent can make that choice.
What Happens if My Parent Lives Longer Than 6 Months on Hospice?
Hospice can continue. Medicare covers two 90-day benefit periods followed by an unlimited number of 60-day periods, as long as the hospice doctor recertifies at the start of each period that your parent is still terminally ill.
Can My Parent Keep Their Own Doctor?
Yes. A hospice doctor joins the medical team, and your parent can choose their regular doctor, nurse practitioner or physician assistant as the attending professional. Care for the terminal illness must come from or be arranged by the hospice team.
Does a Medicare Advantage Plan Change Hospice Coverage?
Once hospice starts, Original Medicare covers everything related to the terminal illness, even if your parent stays in a Medicare Advantage plan. The plan can keep covering extra benefits and care for unrelated health problems as long as your parent pays its premiums.
Do Veterans Pay Anything for VA Hospice Care?
No. VA says there are no copays for hospice care, whether VA provides it or a community organization with a VA contract does. All enrolled Veterans with a terminal condition and less than 6 months to live who are no longer seeking curative treatment can qualify.
More on Types of Care
- Memory CareSecured dementia care in assisted living and nursing homes, state rules and how to pay
- Assisted Living vs Nursing HomeHow the two settings differ in care, rules and who pays
- Memory Care vs Assisted LivingWhen a person with dementia needs a secured memory care unit
- In-Home CarePersonal care, homemaker help and how Medicaid and VA pay for it
- Home Health vs Home CareThe difference between Medicare home health and paid personal care
- Adult Day CareDaytime programs, health services and coverage
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.