By Mary McElroy
Yes, Medicare Part A covers hospice care. When a patient meets eligibility requirements, Medicare pays for the full cost of hospice services. For most families, the total out-of-pocket cost is $0. A small co-pay of up to $5 per prescription may apply to certain outpatient medications. No deductible. No monthly premium for the hospice benefit itself.
If someone in your family has been referred to hospice, cost is likely one of your first concerns. Here’s exactly what Medicare covers and what you can expect.
What Does Medicare Cover Under the Hospice Benefit?
The Medicare hospice benefit, authorized under Social Security Act Section 1812(a)(4) and governed by 42 CFR Part 418, covers all care related to the terminal illness, coordinated by the hospice’s interdisciplinary group. Here’s what’s included, and what isn’t.
One detail surprises most families: Medicare Part A covers bereavement support for 13 months after the patient’s death as part of the hospice benefit. The support doesn’t stop on the day your loved one dies.
Full coverage, no deductible, no monthly premium: that’s the shape of it for any beneficiary who has elected the benefit and meets Medicare’s eligibility rules. For a fuller picture of what the care itself looks like day to day, visit our hospice care services page.
The Four Levels of Medicare Hospice Care
Medicare defines four distinct levels of hospice care under federal regulation (42 CFR § 418.302(c)). These aren’t steps on a ladder. They’re clinical responses to what the patient needs at any given time, and a patient can move between levels as their condition changes. A Medicare-certified hospice must be capable of providing all four levels.
Routine Home Care
Routine home care is the default, and by far the most common: it accounts for roughly 97 to 98 percent of all Medicare hospice days. The patient stays wherever they already live (their own home, a family member’s home, a nursing home, or an assisted living facility), and the interdisciplinary group visits on an intermittent basis: nurses, home health aides, social workers, chaplains, and therapists, as needed. The hospice coordinates every medication, piece of equipment, and supply related to the terminal illness.
Cost to your family: $0.
Most families will spend nearly all of their time on this level. Community Hospice & Palliative Care’s team visits patients wherever they live across 16 counties in northeast and north central Florida.
Continuous Home Care
Continuous home care exists for one reason: a medical crisis at home. If symptoms like uncontrolled pain, respiratory distress, or acute agitation start requiring sustained skilled nursing, this level kicks in so the patient can stay home instead of being hospitalized. Medicare requires at least eight hours of skilled nursing care in a 24-hour period, with most of those hours covered by a registered nurse or social worker.
It’s meant to be short-term. The hospice team manages the crisis, stabilizes the patient, and transitions back down to routine home care, sometimes with a nurse present overnight until things settle.
Cost to your family: $0.
Inpatient Respite Care
Inpatient respite care works a little differently: it exists for the caregiver, not the patient. It’s a short-term stay (up to 5 consecutive days) at a Medicare-approved inpatient facility so the family members doing the day-to-day caregiving can rest. The patient doesn’t need inpatient-level medical care during this time; the purpose is relief, not symptom management.
Community Hospice provides this at its 9 Centers for Caring, including the Anne and Donald McGraw Center for Caring. While your loved one stays at one of our inpatient facilities, family members can step back, sleep, and recover their strength.
Cost to your family: a small coinsurance, 5 percent of the Medicare-approved daily rate, capped at the annual inpatient hospital deductible ($1,676 in 2025). For a typical 3- to 5-day stay, that amount is modest.
General Inpatient Care
General inpatient care is the other side of that coin: it’s for acute symptom management that can’t be controlled at home, even with continuous home care in place. When pain, breathing problems, or other symptoms need around-the-clock clinical intervention in a facility setting, this is the level that applies.
It can happen at one of Community Hospice’s Centers for Caring (the Anne and Donald McGraw Center for Caring, for instance) or at a hospital or skilled nursing facility under contract with the hospice, as permitted under 42 CFR Part 418.
Cost to your family: $0.
The distinction worth remembering: general inpatient care addresses the patient’s acute medical needs, while inpatient respite care addresses the family’s capacity to keep caregiving. The two aren’t interchangeable.
Who Is Eligible for the Medicare Hospice Benefit?
Three conditions must all be met to qualify for the Medicare hospice benefit. For more on how to recognize when hospice may be the right choice, see our post on signs that it may be time for hospice.
1. Enrolled in Medicare Part A. The hospice benefit is a Medicare Part A (Hospital Insurance) benefit. Most Medicare beneficiaries have Part A automatically. No additional steps are required to activate Part A if you’re already enrolled.
2. Two-physician certification of terminal prognosis. The patient’s attending physician AND the hospice medical director must both certify in writing that the patient has a life expectancy of 6 months or less if the illness runs its normal course. This two-physician certification rule applies to the initial election. The statutory language is intentional: it acknowledges that prognosis is a clinical judgment under uncertainty, not a guarantee or countdown.
Patients who live longer than 6 months remain fully eligible. The 6-month prognosis rule applies to the certification standard, not to how long coverage can continue. Many patients have lived for a year or more on hospice, and their Medicare hospice coverage continued throughout, through successive benefit periods and recertification.
From the third benefit period onward, Medicare Administrative Contractors and Local Coverage Determinations require a hospice physician or nurse practitioner to conduct a face-to-face encounter with the patient before recertification is valid.
3. Election of the hospice benefit. The patient (or legal representative) signs a hospice election statement, formally choosing hospice care and waiving Medicare coverage for curative treatment of the terminal illness. Medicare coverage for all other conditions continues without change.
This point causes confusion for many families. Electing the hospice benefit doesn’t mean losing Medicare. If the patient has diabetes, a broken arm, or any condition unrelated to the terminal diagnosis, Medicare continues to cover treatment for those conditions exactly as before. The waiver applies only to curative treatment of the specific terminal illness.
How Much Does Hospice Cost With Medicare?
For most families, the answer is nothing.
Here’s the full out-of-pocket breakdown for Medicare hospice costs:
- Routine home care: $0
- Continuous home care: $0
- General inpatient care: $0
- Outpatient prescription medications for symptom management: Up to $5 per prescription. Medications administered by the hospice nurse during a visit or in an inpatient setting: $0
- Inpatient respite care: 5 percent coinsurance, capped at $1,676 for the year (2025 rate)
- Medicare Part A deductible: Not applicable to the hospice benefit
- Monthly premium specific to hospice: None
What does Medicare pay for hospice when the patient lives in a nursing home? Medicare doesn’t cover room and board. Families continue to pay those housing costs to the facility. Medicare hospice coverage pays for the clinical care provided by the interdisciplinary group. Medicaid can cover room and board for patients who are Medicaid-eligible, which we cover in the next section.
Is There a Time Limit on Medicare Hospice Coverage?
Medicare doesn’t cut off hospice coverage when a patient reaches 6 months. The 6-month prognosis rule is the certification standard, not a payment cutoff.
The hospice benefit periods are structured as follows: two initial 90-day periods, then unlimited 60-day periods. At the start of each benefit period, the hospice recertifies the patient through the Medicare Administrative Contractor responsible for that region. If the patient still meets the 6-month prognosis criterion, coverage continues. There’s no regulatory cap on the number of benefit periods a patient can receive under the Medicare hospice benefit.
Beginning with the third benefit period, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the patient and document it before the recertification is valid. This is a standard clinical review, not an obstacle to continued coverage.
If a patient’s condition improves and they no longer meet the 6-month prognosis criterion, the hospice discharges them and they return to standard Medicare coverage. If the patient later meets the criterion again, they can re-elect the hospice benefit. Patients can also revoke the hospice election at any time, for any reason, and return to standard Medicare immediately.
Hospice isn’t a locked door. It’s a choice your family can step into and, if circumstances change, step out of.
What If My Loved One Does Not Have Medicare?
Medicare isn’t the only path to hospice care. Other coverage options exist, and Community Hospice works with all of them.
Medicaid works alongside Medicare in a similar way: it covers all four levels of hospice care, requires physician certification, and follows the same election and waiver process. One notable difference: in most states, Medicaid also covers nursing home room and board for eligible patients, which Medicare won’t pay for. If your loved one has both Medicare and Medicaid, Medicare is the primary hospice payer.
For veterans enrolled in VA health care, the Veterans Affairs (VA) hospice benefit covers care with no copay, and it works alongside Medicare for veterans who have both.
Most commercial private insurance plans cover hospice as well, though the specifics depend on the plan. Before care begins, our financial counseling team can verify your loved one’s coverage and explain any out-of-pocket costs upfront.
And if coverage still falls short? Community Hospice & Palliative Care is a 501(c)(3) nonprofit, and our charitable care funds are there to support families whose coverage doesn’t stretch far enough.
If you’re unsure what coverage your family member has, or whether it covers hospice, our team can help you find out. You don’t have to figure this out alone.
If you’re trying to understand whether hospice or palliative care is the right fit for your situation, our post on hospice versus palliative care explains the key differences.
How Community Hospice Works With Your Family on Coverage
We’ve been caring for families in northeast Florida for 47 years, since our founding in 1979, and in that time we’ve helped thousands of them understand and use the Medicare hospice benefit. Today, Community Hospice & Palliative Care supports approximately 1,500 patients every day across 16 counties in northeast and north central Florida.
Our admissions team walks families through the Medicare hospice benefit and the hospice benefit election every day. We verify insurance coverage, handle paperwork, and make sure families know exactly what to expect before care begins. Community Hospice’s financial counseling team is available to review Medicare hospice coverage, explain out-of-pocket costs, and connect families with charitable support if needed. Families aren’t left to figure this out alone.
When you call, you’ll speak with a real person. Not a phone tree. Not a form. A member of our team who can answer your questions about Medicare hospice costs, verify your loved one’s insurance, and walk you through the next steps.
Community Hospice operates 9 Centers for Caring across the region, including the Anne and Donald McGraw Center for Caring, the Earl B. Hadlow Center for Caring, the Alice and T. O’Neal Douglas Center for Caring, the Jane and Bill Warner Center for Caring, and the Bailey Family Center for Caring at UF Health Flagler. Learn more about all our locations and services.
“The recognition as a Hospice Honors Elite program places Community Hospice among the top 2% of hospices nationwide, and we are honored to be the only hospice in the state of Florida to receive this designation, a testament to the exceptional quality and heartfelt care our team delivers each day.”
Frequently Asked Questions About Medicare and Hospice
Does Medicare cover hospice at home?
Yes. Medicare Part A covers hospice care delivered at home at 100% for eligible beneficiaries. Home includes your own residence, a family member’s home, an assisted living facility, or a nursing home. This is called routine home care and accounts for the vast majority of all Medicare hospice days. Your hospice team visits you where you live and coordinates all medications, equipment, and supplies. The cost to your family is $0.
How much does hospice cost with Medicare?
For most families, the total out-of-pocket cost is $0. Medicare Part A covers routine home care, continuous home care, and general inpatient care at no cost to the family. Outpatient prescription medications for symptom management carry a co-pay of up to $5 per prescription. Inpatient respite care has a 5% coinsurance, capped at the annual inpatient hospital deductible. There’s no Medicare Part A deductible for hospice and no monthly hospice premium.
“No one is ever denied services through Community Hospice, regardless of their ability to pay.”
Is there a time limit on Medicare hospice coverage?
No. Medicare doesn’t cut off hospice coverage at 6 months. The benefit is structured as two initial 90-day periods, then unlimited 60-day periods. At the start of each period, the hospice recertifies the patient. If the patient still meets the 6-month prognosis criterion, coverage continues with no regulatory cap on the total number of periods. Patients who live longer than expected remain fully covered throughout.
Does Medicare cover inpatient hospice care?
Yes. Medicare covers two types of inpatient hospice care. General inpatient care, for acute symptoms that can’t be controlled at home, is covered at 100%. Inpatient respite care, which gives family caregivers a short-term break (up to 5 consecutive days at a Medicare-approved facility), carries a 5% coinsurance. Community Hospice provides both types at its 9 Centers for Caring across northeast and north central Florida.
What does the Medicare hospice benefit include?
The Medicare hospice benefit covers physician services, nursing care, medications related to the terminal illness, durable medical equipment (hospital bed, oxygen, wheelchair, commode), medical supplies, home health aide services, social work, chaplain and spiritual care, physical and occupational therapy when needed, and bereavement support for the family for 13 months after the patient’s death. The entire interdisciplinary team is covered. The hospice coordinates all of it.
What is the Medicare hospice benefit election?
The hospice benefit election is a formal statement signed by the patient or legal representative. By signing, the patient chooses hospice care and waives Medicare coverage for curative treatment of the terminal illness. Medicare coverage for all other conditions continues exactly as before. The election doesn’t mean losing Medicare. It means directing Medicare’s coverage of the terminal illness toward comfort and quality of life rather than curative treatment.
Can I keep my regular doctor on hospice?
In most cases, yes. The patient’s attending physician can continue to participate in their care under the Medicare hospice benefit. The attending physician works alongside the hospice medical director as part of the interdisciplinary team. One of the two-physician certification requirements for hospice eligibility specifically involves the attending physician, so their continued involvement is built into how the benefit works.
What if my loved one lives longer than 6 months on hospice?
Coverage continues. The 6-month prognosis rule is the certification standard, not a payment deadline. As long as the hospice can recertify that the patient still meets the prognosis criterion at the start of each benefit period, Medicare coverage continues without interruption. Many patients receive hospice care for a year or more. If a patient’s condition improves and they no longer qualify, they’re discharged and can return to standard Medicare. They can re-elect the hospice benefit later if they qualify again.
Can we leave hospice and go back to regular Medicare?
Yes, at any time and for any reason. A patient can revoke the hospice election and return to standard Medicare immediately. There’s no penalty. If the patient later meets the eligibility criteria again, they can re-elect the hospice benefit. Families sometimes leave hospice to pursue a specific treatment, then return to hospice when that treatment is complete or when comfort care becomes the priority again.
What if my loved one does not have Medicare?
Other coverage options exist. Medicaid covers hospice on a benefit structure that closely mirrors Medicare, and Medicaid in most states covers nursing home room and board for eligible patients, which Medicare doesn’t. VA benefits cover hospice for eligible veterans at no co-pay. Most private insurance plans cover hospice as well, though specifics vary by plan. Community Hospice’s financial counseling team can verify coverage before care begins and explain any out-of-pocket costs. Call us at 866-253-6681.
Next Steps: Talking to Community Hospice About Medicare Coverage
If your family is facing a hospice decision and you want to understand your coverage before anything else, call us at 866-253-6681. A real member of our team will answer.
You can ask about Medicare hospice coverage, verify your loved one’s insurance, or simply ask what to expect. Calling isn’t enrollment. It’s information-gathering, and there’s no obligation.
“No one is ever denied services through Community Hospice, regardless of their ability to pay.”
Community Hospice & Palliative Care serves patients across 16 counties in northeast and north central Florida. If your family is outside our service area, we can help connect you with resources in your region.
For official Medicare information on the hospice benefit, visit medicare.gov/coverage/hospice-care.
Mary McElroy
Oversees all clinical nursing and nursing assistant functions, including inpatient, home care, long term care, triage and nursing services administration. Mary received a Bachelor of Science in Nursing from Villanova University and a Master of Science in Administration and Health Services from Central Michigan University. In 2003, she was honored as one of the Great 100 Nurses of Northeast Florida.