Hospice, plainly

What it is, and who qualifies

Hospice is care focused on comfort for the last stage of an illness a person will die from. These are Medicare's conditions:^[1]

• You have Part A.
• Your hospice doctor, and your regular doctor if you have one, certify that you have an illness you will die from and are expected to live six months or less.
• You accept comfort care in place of treatment meant to cure that illness.
• You sign a statement choosing hospice care.

The six months is not a deadline. Coverage comes in two 90-day periods, then as many 60-day periods as needed. Past six months, the hospice doctor or medical director must approve it again, after a face-to-face meeting between the patient and the hospice doctor or a hospice nurse practitioner.^[1]

What you pay, and the two things Medicare does not cover

Covered services from a hospice approved by Medicare generally cost nothing. Beyond that:^[1]

• Drugs you take at home for pain and symptoms: a copay of up to $5 per prescription.
• A respite stay in a facility: 5% of the amount Medicare approves, and no more than the hospital deductible. This is the benefit that lets a family rest. Ask about it early. See respite care.

Now the limits, because these are what surprise families:

• Room and board is not covered — not at home, not in a nursing home, not in a hospice facility.^[1] If your person lives in a facility, the facility's bill does not go away when hospice starts.
• Care for problems not related to the illness they are dying from is still covered by Original Medicare, but with the usual deductibles and coinsurance.^[1]
• All care for that illness must be given or set up by the hospice you chose. You do have the right to change to a different hospice once in each benefit period.^[1] You can also keep your regular doctor or nurse practitioner to help oversee the care.

You can stop, and you can go back

This is the part that takes away most of the fear, and it is in Medicare's own words: "you always have the right to stop hospice care at any time." If your health gets better or the illness eases, you or the doctor may decide hospice is no longer needed. To stop, you sign a form with the end date. Then your Original Medicare or Medicare Advantage coverage starts again. And: "If you qualify, you can go back to hospice care at any time."^[1]

Know one protection before anyone hands you papers. Medicare says plainly that no one from the hospice team should ask you to sign forms about stopping hospice when you start. Stopping is a choice only the patient makes. And you should not sign or date any such form until the real date you want care to stop.^[1] If someone does ask you, that is not how the benefit is supposed to work.

How late families start, in numbers

These numbers come from a March 2025 report to Congress by MedPAC, a federal advisory group, using 2023 Medicare data. 51.7% of people on Medicare who died had hospice care, up from 49.1% in 2022. Among those who used it, the median time in hospice was 18 days and the average was 96.2 days.^[2] (The median is the middle: half had less, half had more.)

That gap between 18 and 96 is worth understanding. Most stays are short, and a smaller number are very long. One in ten stays was 2 days or less. One in four was 5 days or less. One in ten was 278 days or more. More than a quarter of the people who died in hospice signed up only in the last week of life. Yet stays longer than 180 days cost more than $15 billion, just over 60% of hospice spending.^[2]

So both things are true at once. A large group starts within days of death, and a smaller group stays a long time. These numbers are about people on Medicare who died. They show when people signed up, not why. We are not going to tell you the reason is denial. What we can say is that asking a doctor about hospice does not start anything, and the benefit is built to last months.

What only local people can tell you

Would your person be certified? Which hospices serve your area? Those are local questions.

Who to ask: the person's doctor ("is it time to talk about hospice, and would they qualify?"); and any hospice approved by Medicare, which will come for a visit to explain things with no commitment.

What to ask them:

• Given how my person is doing now, would they likely be certified? If not, what would show that it is time?
• Which hospices serve this area? Can we meet them before we decide anything?
• What does the first week at home really look like?
• Who is on your team? How often does each person visit? Who answers the phone at 2 a.m.?
• How does a respite stay work here? How much notice do you need?
• Do you offer grief support for the family? For how long?
• If my person lives in a facility, what will we still pay for room and board?

Quick answers

Who qualifies for hospice under Medicare?

You need Part A. Your hospice doctor, and your regular doctor if you have one, must certify that you have an illness you will die from and are expected to live six months or less. You accept comfort care in place of treatment meant to cure that illness. And you sign a statement choosing hospice. Coverage comes in two 90-day periods, then as many 60-day periods as needed. Each one must be approved again. After six months, that takes a face-to-face meeting with the hospice doctor or nurse practitioner. [1]

What does hospice cost with Medicare?

Covered hospice services from a hospice approved by Medicare generally cost you nothing. Drugs you take at home for pain and symptoms can have a copay of up to $5 per prescription. A respite stay in a facility costs 5% of the amount Medicare approves, and no more than the hospital deductible. Two limits matter. Medicare does not cover room and board, at home or in a nursing home or hospice facility. And care for health problems that are not part of the illness you are dying from, or related to it, still has the usual deductibles and coinsurance. [1]

How long do people usually have hospice care?

In 2023, 51.7% of people on Medicare who died had hospice care, up from 49.1% in 2022. Among those who used it, the median time in hospice was 18 days, while the average was 96.2 days. (The median is the middle: half had less, half had more.) The gap between the two is the story. A smaller number of very long stays pulls the average up. More than a quarter signed up only in the last week of life. At the other end, stays over 180 days cost more than $15 billion, just over 60% of hospice spending. [2]

Where to go next

• Palliative care
• Respite for the caregiver
• The three documents