Medicare hospice coverage: how long it lasts

If you're here, you're probably trying to make a caring, thoughtful choice for yourself or someone you love. Let's get right to the heart of it: Medicare hospice coverage lasts in benefit periodsan initial 90 days, a second 90 days, and then unlimited 60day periods. As long as a hospice doctor and your regular doctor continue to certify that you're terminally ill with a life expectancy of six months or less, Medicare will keep paying for hospice care. There's no hard cutoff if you still qualify.

What does that really look like day to day? Hospice focuses on comfortrelieving pain and symptoms, supporting your emotional and spiritual needs, and helping families breathe a little easier. Most care happens right where you live: at home, in assisted living, or in a nursing facility. There are wonderful benefits, and there are tradeoffs and limits you should know about before you make that hospice election. I'll walk you through all of it, in plain language, like a friend at your kitchen table.

What's covered

Medicare hospice benefits are designed around one clear goal: quality of life. If you've ever watched a loved one bounce between appointments and hospital stays, you'll understand how radical it feels when the care team says, "We'll come to you."

Core hospice services covered

Here's what Medicare hospice coverage typically includes. Think of it as a circle of support around you and your family:

Regular nursing visits to manage pain, shortness of breath, nausea, anxiety, and other symptoms, plus oncall support 24/7 for urgent needs. You're never left wondering who to call at 2 a.m.
Physician services from the hospice medical director and your attending doctor to lead your plan of care and adjust medications as needs change.
Medications related to your terminal diagnosis and symptom controllike opioids for pain, antinausea meds, inhalers, and anxiety medicationsdelivered to your home when possible.
Durable medical equipment (DME), such as a hospital bed, wheelchair, oxygen, bedside commode, and pressurerelieving mattressso your home can function like a small, safe care setting.
Medical supplies: wound dressings, incontinence supplies, tubing, and more, so caregivers aren't running errands nonstop.
Home health aide (personal care) for help with bathing and groomingdignity matters.
Social work support to navigate benefits, family dynamics, and practical planning.
Chaplaincy/spiritual care if desired, respecting your beliefs and preferences.
Grief counseling for family for up to 13 months after deathbecause support shouldn't stop at the door.

Levels of care

Hospice isn't onesizefitsall. Medicare hospice benefits include four levels of care, adjusted to what you need:

Routine home care: The most common levelregular nursing and aide visits wherever you live.
Continuous home care: Shortterm, intensive nursing at home during a crisis (for example, uncontrolled pain or severe breathing distress) to keep you comfortable without a hospital trip.
General inpatient care: When symptoms can't be managed at home safely, you can receive shortterm care in a hospital or hospice inpatient unit.
Inpatient respite care: Up to five days in a Medicareapproved facility to give caregivers a breather. It's okay to need rest.

What Medicare does not cover under hospice

There are important boundaries to understand. Under the hospice election, Medicare will not pay for:

Curative treatments for your terminal diagnosis (like chemotherapy intended to cure or significantly prolong life). The focus shifts to comfort.
Room and board in assisted living or nursing homes, except during the short inpatient levels of care above. If you live in a facility, you or another payer typically cover daily room/board.
Emergency room visits or hospitalizations not arranged by your hospice team. Always call hospice first when possiblethey can often treat at home or coordinate the right setting.
Medications unrelated to your hospice diagnosis. Those may still be covered by your Part D plan or other benefits; your hospice will help sort this out.

How costs work

Good news: there's no deductible for hospice itself. For most services, your cost is $0. You may have small copaysup to $5 per prescription for symptom control and 5% of the Medicareapproved amount for inpatient respite care. If a medication is not related to your hospice diagnosis, it might go through your Part D plan with standard copays or coinsurance.

Where you can receive hospice care

Hospice meets you where you are. Care can be provided at home (the most common), in an assisted living facility, or in a nursing home. If you live in a facility, hospice covers the clinical care, while room and board usually remain your responsibility unless a short inpatient level is needed. Some communities have hospice inpatient units or contracts with hospitals for general inpatient care when symptoms get tough.

How long it lasts

This is the question families ask most: "How long will Medicare pay for hospice care?" The relief comes in knowing there's no set maximum if you qualify.

Understanding benefit periods

Here's the structure, simple and clear:

First benefit period: 90 days
Second benefit period: 90 days
Then: Unlimited 60day periods

You move through these periods as long as you remain eligiblemeaning your hospice doctor and your regular doctor certify that your prognosis is six months or less if the illness follows its normal course.

Recertification and continued eligibility

To keep things on track, your hospice team completes recertifications at specific times. Starting at day 180 (the beginning of your third period), a hospice clinician must complete a facetoface visit each subsequent 60day period to confirm eligibility. This is not a test; it's a thoughtful checkin to make sure hospice is still the right level of support for you.

What happens if your condition stabilizes or improves

Sometimes people feel better on hospice; good symptom control can do that. If your condition stabilizes and you no longer meet criteria, your hospice may discharge youthis is called a "live discharge." It can feel strange, but it's actually a sign the plan worked. If your health worsens later and you again meet eligibility, you can reelect hospice and resume care.

Can you get hospice more than once?

Yes. There's no limit to subsequent 60day benefit periods as long as you're recertified. People often move in and out of hospice depending on their illness trajectory. You're not "using up" hospice in a way that prevents you from receiving it later when appropriate.

Who qualifies

Let's unpack hospice care eligibility under Medicare without the jargon.

The 6month prognosis rule

The standard is "a life expectancy of six months or less if the disease runs its normal course." That last part matters. It's a clinical judgment, not a stopwatch. Some conditions have a straight path (certain cancers), while others, like heart failure or COPD, can ebb and flow. Doctors rely on patterns, functional decline, symptom burden, and test results to make a goodfaith estimate and document why hospice makes sense.

Terminal diagnosis vs. unrelated conditions

Your hospice identifies which medications and services are related to your hospice diagnosis. Those are covered under the hospice benefit. Unrelated carelike a longstanding unrelated conditionmay still be covered by your other Medicare benefits or Part D plan. When in doubt, ask the hospice physician to explain their reasoning so you're not stuck at the pharmacy counter guessing.

Who can refer you and how to enroll

Anyone can ask about hospicepatients, family, your primary care doctor, or your specialist. If hospice feels right, you'll sign an election of benefit form choosing a Medicarecertified hospice. You can switch hospices if needed (more on that soon), and you can revoke hospice if you decide to pursue curative treatment again. It's your choice.

Tradeoffs and benefits

Making the hospice election involves weighing warmth and support against some real limits. Let's be honest about both.

Why families choose hospice

A care team centered on comfort: nurses, doctors, aides, social workers, chaplains.
Inhome support that reduces hospital trips and scary nights without answers.
Help for caregiverscoaching, respite options, and honest conversations.
24/7 oncall support so you're not alone when symptoms flare.

Risks and limitations to understand

You agree to pause curative treatments for your terminal diagnosis. Some palliative treatments (like radiation to reduce pain) may still be covered if the purpose is symptom relief, not cure.
If you live in an assisted living or nursing home, you'll likely pay room and board outofpocket unless another program helps.
Hospices have formulariespreferred medicationsand may need prior authorization for certain drugs. Ask what's covered and how quickly they can deliver.
Changing hospices can affect which medications and equipment are covered, so plan transitions carefully.

Combining hospice with other Medicare coverage

If you're on Original Medicare, hospice is covered under Part A. Services unrelated to your hospice diagnosis may still be billed to Part B or Part D. If you're in a Medicare Advantage plan, the hospice benefit is still provided by Medicare, while your plan may offer supplemental benefits like meal delivery or transportation. Many families find it helpful to review scenarios with a social worker so there are no surprises.

When hospice may not be the right fityet

If you're still pursuing diseasedirected treatment and don't feel ready to pause it, consider palliative carea sister service that focuses on quality of life while you continue other therapies. You can also ask your doctor for a "goalsofcare" visit to explore what matters most to you right now. Sometimes the answer is, "Not yet," and that's okay.

Practical steps

Here's a simple roadmap for the next week or two, because action beats overwhelm.

How to compare and choose a hospice

Interview at least two Medicarecertified hospices. Ask:

How fast do you respond after hours? What's your average response time?
How often will a nurse visit? What about a home health aide?
Which common medications and equipment are covered for my condition?
How do you train family caregivers? Do you provide written guides and contacts?
What languages and cultural supports do you offer?
What are your quality ratings and how do you gather family feedback?

To check quality, families often look at CMS Care Compare and the CAHPS Hospice Survey results (according to CMS Care Compare), which report family experience and selected quality measures.

What to expect in the first 72 hours

Admission visit: A nurse reviews your history, assesses symptoms, and creates a plan.
Care plan: You'll receive a written plan with diagnoses, medications, visit schedules, and who to call.
Equipment delivery: Beds, oxygen, or a wheelchair show up fastoften within a day.
Medication reconciliation: The team clarifies which meds are for comfort and which may shift to Part D or be stopped if not needed.
Emergency contacts: You'll get a 24/7 number. Put it on the fridge. This is your lifeline.

Planning for crises and respite

Ask your hospice how they handle sudden pain spikes, agitation, or breathing distress. When do they provide continuous home care? What triggers general inpatient care, and where would that happen? If you're a caregiver, plan respite noweven a fiveday break can be the difference between coping and burning out. Also talk through transport logistics so you're not scrambling later.

Documenting wishes

If you haven't already, complete advance directives and, if used in your state, a POLST or MOLST form. Decide on resuscitation preferences (DNR or not) and make sure copies live in all the right places: with the hospice team, at home where responders can see them, and with any facility. Clarity is a kindness to your future self and your family.

Costs and billing

Let's head off common surprises before they happen.

Typical copays and how to avoid unexpected bills

Remember: $0 for most hospice services, up to $5 per prescription for symptom control, and 5% coinsurance for inpatient respite care. If a medication is deemed unrelated to your hospice diagnosis, it may bill to your Part D plan with normal copays. To avoid confusion, keep a running list of meds with notes on who covers what. If something feels off, call the hospice nurse or social workerthey troubleshoot these issues daily.

Room and board in facilities

If you live in assisted living or a nursing facility, hospice covers your clinical care, but not the room and board. Families often explore Medicaid longterm care or Veterans benefits to help. A good hospice social worker is worth their weight in gold for navigating these programs.

Medicare Advantage members

If you're in a Medicare Advantage plan, hospice services are still paid by Medicare, but your plan may provide extra support like overthecounter allowances, transportation, or caregiver training. Prior authorization rules may apply to some supplemental benefits, so ask your plan and hospice to coordinate. The hospice team usually knows how to make the puzzle pieces fit.

Appeals, complaints, and your rights

You have strong rights. If hospice plans to stop a service, you should receive a Notice of Medicare NonCoverage (NOMNC) with appeal instructions. You can also change hospices without penalty if another provider is a better fit. Keep notes, ask for things in writing, and don't hesitate to request a physician review when you disagree about what's "related" to your diagnosis.

Special situations

Real life isn't tidy, so let's talk through a few scenarios.

Leaving hospice to try treatment, then coming back

You can revoke hospice at any time if you decide to pursue curative treatment. Later, if you again meet eligibility, you can reelect hospice. You won't lose your ability to receive future benefit periods.

Does hospice ever cover chemotherapy or radiation?

Sometimes, yesif the goal is symptom relief, not cure. For example, a short course of radiation to reduce bone pain may be covered. Your hospice physician will document the intent and expected benefit and obtain approvals as needed.

Keeping your primary care doctor

Many people keep their primary care doctor as their "attending physician." The hospice medical director coordinates with them so everyone is rowing in the same direction. If you love your doctor, say socontinuity of trust matters.

If a medication is labeled "unrelated"

Ask the hospice physician to explain the determination. If it's truly unrelated, it may be covered by Part D. If you disagree, request a review and provide clinical notes if you have them. Clear communication solves many pharmacy headaches.

How grief support works

After death, your hospice's bereavement team checks in with your family for at least 1213 months. Services may include phone calls, support groups, mailings, and oneonone counseling. Grief is not linear; it helps to have a steady hand nearby.

Evidence and trust

You deserve care that's both compassionate and highquality. Medicare hospice coverage is guided by federal rules and quality measures. Families often compare providers using publicly reported experience data and accreditation. The Centers for Medicare & Medicaid Services publishes hospice quality and family ratings (a study referenced in the Hospice Quality Reporting Program), and groups like CHAP or the Joint Commission accredit hospices that meet additional standards. These aren't just logosthey signal a culture of accountability.

Red flags to watch for

Pressure to enroll without a clear explanation of your prognosis or goals.
Vague answers about what's covered, especially around medications and equipment.
Slow afterhours response or difficulty getting needed meds quickly.
Lack of a clear plan for symptom crises or caregiver training.

If you see these, keep asking questionsor interview another hospice. You are hiring a team to support you at one of life's most important times. You're allowed to be picky.

Let me leave you with two short, realworld snapshots. First, Mr. L with advanced COPD: he was tired of bouncing back to the ER for breathlessness. With hospice, he got oxygen at home, fastacting meds, and a nurse who taught his daughter what to do when panic and air hunger struck. He stayed on hospice for eight months, stabilizing enough to be discharged for a while, then reelected when symptoms worsened. Second, Ms. R with metastatic cancer: she chose hospice when pain and fatigue overshadowed treatment. Her team quickly switched to a longacting pain plan, delivered a hospital bed, and arranged five days of respite so her sister could rest. She once told me, "I felt the floor under my feet again." That, right there, is the heart of hospice.

What questions are still on your mind? What would make this decision feel more doable today? If you're weighing Medicare hospice benefits, it's okay to take a breath, gather information, and move at your pace. You're not alone in this.

Bottom line: Medicare hospice coverage can last as long as you need ittwo 90day periods, then unlimited 60day periodsas long as doctors confirm you remain eligible. The benefit centers on comfort and dignity: expert symptom control, inhome visits, equipment, and family support. The tradeoffs are realespecially pausing curative treatments for the terminal diagnosis and paying room/board in facilitiesbut many families find the peace of mind priceless. Your best next steps: confirm eligibility, interview at least two Medicarecertified hospices, and ask specific questions about afterhours care, medications, and equipment. If your needs change, you can switch hospices, revoke, or reelect later. We're all walking each other home; it's okay to ask for steady company along the way.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.