The Medicare Hospice Benefit Explained Simply
Medicare Part A covers hospice care at nearly 100% — but the rules around eligibility, election, revocation, and benefit periods confuse almost everyone. This guide cuts through the bureaucracy and explains the Medicare Hospice Benefit in plain, human language so you can make informed decisions quickly.
## The Short Version
Medicare Part A covers hospice care — and it covers it *comprehensively*. For most families, the cost is effectively zero. No deductible. No copay for nursing visits. No charge for medications related to your loved one's terminal illness.
If that sounds too good to be true, read on. It isn't.
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## Who Qualifies
To elect the Medicare Hospice Benefit, two conditions must be met:
1. **A terminal illness** with a prognosis of **six months or less** if the disease runs its normal course 2. **Certification by two physicians** — typically your loved one's attending doctor and the hospice medical director
Your loved one also must be enrolled in Medicare Part A and agree to shift the focus of care from curative treatment to comfort.
That last part is the pivot. It doesn't mean stopping all medications — it means redirecting care toward managing symptoms rather than treating the underlying disease.
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## What Medicare Covers Under Hospice
Here's what the Medicare Hospice Benefit actually covers, all related to the terminal diagnosis:
**Medical services** - Registered nurse visits (as frequent as needed, including 24/7 on-call) - Physician oversight from the hospice medical director - Home health aide visits for personal care
**Medications** - All medications related to the terminal diagnosis — delivered to your home - Typically covered at 100% or with a small copay (no more than $5 or 5% of the drug cost for outpatient medications)
**Durable Medical Equipment (DME)** - Hospital bed, wheelchair, walker, commode - Oxygen equipment and supplies - All delivered and set up by the hospice agency
**Support services** - Medical social worker for family support and resources - Chaplain or spiritual counselor - Volunteer services - Bereavement counseling for the family for 13 months after the death
**What you pay**: For most hospice services, **$0**. A small copay may apply for outpatient medications ($5 or 5%, whichever is less) and for inpatient respite care.
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## The Four Levels of Hospice Care
Medicare structures hospice as four levels, depending on what your loved one needs:
**1. Routine Home Care** The most common level. The hospice team visits regularly at home, manages medications, and provides support. The patient isn't in a medical facility.
**2. Continuous Home Care** Intensive care at home during a short-term medical crisis — pain that's suddenly difficult to control, or severe anxiety. A nurse or aide may be present for hours at a time. This is temporary, aimed at stabilization.
**3. Inpatient Respite Care** Short-term inpatient care (up to five days at a time) to give family caregivers a break. The patient stays at a Medicare-approved facility. You pay 5% of the Medicare-approved amount for this level.
**4. General Inpatient Care** When symptoms can't be managed at home. This is a higher level of care in a hospital or hospice facility. Fully covered by Medicare.
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## The Benefit Periods
Medicare hospice doesn't have a fixed time limit on care — but it does have a structure:
- **First benefit period**: 90 days - **Second benefit period**: 90 days - **Subsequent periods**: Unlimited 60-day periods
At the start of each period, the hospice physician re-certifies that your loved one still qualifies (still meets the six-months-or-less prognosis). As long as that's the case, hospice continues.
**There is no cap.** People can remain on hospice for years if they continue to qualify. The six-month prognosis isn't a deadline — it's a medical estimate.
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## You Can Revoke Hospice at Any Time
This is important: **electing hospice is not a one-way door.**
If your loved one's condition improves, or if the family decides to pursue curative treatment again, you can revoke the hospice benefit at any time. Your Medicare coverage for the underlying illness picks back up immediately.
You can also re-elect hospice again later if needed.
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## Medicare Advantage and Hospice: What Most People Don't Know
If your loved one is enrolled in a Medicare Advantage (MA) plan, here's how it works:
When they elect hospice, **the Advantage plan steps aside.** Hospice care is covered under Original Medicare (Part A) — not the MA plan. The MA plan continues to cover non-hospice-related care (like a broken leg that has nothing to do with the terminal illness), but the hospice benefit itself goes through traditional Medicare.
This means the network restrictions and prior authorization requirements of the MA plan don't apply to hospice. You choose the hospice agency you want, and Medicare pays.
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## One More Thing
The paperwork involved in electing hospice can feel overwhelming when you're already exhausted. The hospice intake coordinator will walk you through it. Their job is to make this process as easy as possible.
Ask questions. Ask them again if you need to. That's what they're there for.
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## Next Steps
If you're not sure whether the timing is right yet, **[How to Know When It's Time](/hospice/when-is-it-time)** may help. If you want to understand the conversation you'll need to have with your family, read our **[Conversation Starter Guide](/hospice/conversation-guide)**.
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