Medicare and Hospice: What Is Covered and What Is Not
This is a hard decision to make while you are also facing a loss, and the benefit rules should not add to that weight. This page states the rules plainly so you can focus on your parent, not on paperwork.
This page is general information, not medical advice. Eligibility depends on your parent's medical condition and the hospice team's assessment, so talk to your parent's doctor about the specific case.
Sources: Medicare.gov hospice coverage page; CMS hospice benefit guidance; accessed October 2026.
What Medicare requires for hospice
Four conditions must all be met. First, your parent must be enrolled in Medicare Part A, the part of Medicare that covers hospital and inpatient care. Second, a doctor and the hospice medical director must certify a terminal illness, meaning an illness expected to limit life to six months or less if it follows its usual course. Third, your parent must sign an election statement, a signed statement choosing hospice care instead of treatment aimed at curing the illness. Fourth, care must come from a Medicare approved hospice program.
The six month prognosis is a clinical judgment, not a deadline. The hospice team reassesses at each benefit period, and if your parent's condition changes, the plan changes with it.
What Part A hospice covers
Once elected, the hospice benefit covers the services tied to comfort and symptom control. The table below lists what Part A pays for, with no deductible for these hospice services.
| Covered service | What it means in practice |
|---|---|
| Nursing care | Regular nurse visits that manage symptoms and adjust the care plan |
| Doctor services | Care from the hospice medical team for the terminal illness |
| Drugs for symptom control | Medicines that control pain and other symptoms |
| Medical equipment and supplies | Items such as a hospital bed, walker, and bandages |
| Home health aide and homemaker services | Help with bathing, dressing, and light household tasks |
| Counseling | Support for your parent and family, including spiritual counseling |
| Respite care | Short planned breaks for family caregivers in an approved facility |
| Bereavement support | Grief support for the family after the death |
Drugs and treatment for conditions unrelated to the terminal illness stay outside the hospice benefit. For care unrelated to the terminal illness, ask the hospice team in writing which payer covers it.
What you still pay
The hospice benefit leaves only two small charges. Each outpatient prescription for symptom control carries a copay of up to $5. Inpatient respite care carries coinsurance of 5% of the Medicare approved amount, the amount Medicare approves for that service. There is no deductible for hospice services, and no charge for the hospice services listed in the table above beyond those two items.
Ask the hospice program to put both charges in writing at enrollment. A program that will not do so is one to question before you sign.
How long Medicare pays for hospice
Medicare pays through benefit periods, the blocks of time Medicare uses to authorize hospice. The benefit starts with two 90 day periods. After those, it continues with unlimited 60 day periods, as long as the person still meets the criteria. Each period needs recertification, a fresh check that the person still meets the criteria, signed by the doctor and the hospice medical director.
Does Medicare cover hospice without a time limit? In practice, yes, as long as recertification continues and the criteria are still met. There is no lifetime cap on the number of 60 day periods. If your parent no longer meets the criteria, the hospice discharges them, and they can return to hospice later if the illness progresses again.
Hospice care for dementia
Yes, Medicare covers hospice for dementia when the clinical criteria are met. Eligibility follows Medicare's clinical criteria, and the hospice team assesses whether your parent meets them. This page does not list clinical stages as a checklist, because dementia progresses differently in each person and the team judges the full picture, not one sign alone.
Dementia hospice is often started late, because decline can be slow and uneven. If your parent has repeated infections, trouble swallowing, or steady weight loss, ask the doctor whether a hospice evaluation is timely. An evaluation is an assessment, not a commitment.
Hospice in a nursing home
Medicare pays for hospice services in a nursing home, in the same way it pays for them at home. The hospice team visits, manages symptoms, and supports the nursing home staff. The nursing home keeps providing room, meals, and daily care, and the two teams coordinate the care plan.
Does Medicare cover hospice room and board in a nursing home? No, except during general inpatient care, short stays in a facility for symptoms that cannot be managed at home, or respite care. Outside those stays, the room and board bill stays with the resident. If your parent already pays the nursing home privately, that bill continues during hospice. If money is short, read how to pay for nursing home with no money before the bill grows.
Room and board: the rule to watch
Room and board is the gap most families miss, because the hospice benefit itself is so broad. Medicare does not pay room and board during hospice, except during general inpatient care or respite. That rule holds whether your parent lives at home, in assisted living, or in a nursing home.
At home, room and board is not a separate bill. In a facility, it is the main bill, and it continues during hospice. Before electing hospice in a facility, ask in writing who pays it each month, and get the answer from both the hospice program and the facility.
Medicaid and hospice
Medicaid also covers hospice, and the two programs coordinate for people who qualify for both. Dual eligible, a term for people who qualify for both Medicare and Medicaid, describes that group. For dual eligible residents in a nursing home, Medicaid can cover room and board during hospice, which closes the main gap in the Medicare benefit.
Coordination takes paperwork, so start it early. Ask the nursing home business office which state Medicaid program covers room and board, and ask the hospice program to confirm the split in writing. For the assisted living side of Medicaid rules, read does Medicaid pay for assisted living, and for the Medicare side, read does Medicare pay for assisted living.
What hospice costs without coverage
Some families ask what hospice would cost with no Medicare at all. This page does not state a day rate, because private pay rates differ by provider, region, and level of care, and any single figure would mislead. Providers quote their own rates, so ask any provider you consider for its private pay rate in writing, with the level of care it covers, before you compare.
Most families never need that quote, because the Medicare benefit covers the services above once eligibility is met. If a provider pressures you to sign a private pay agreement before checking Medicare eligibility, pause and get a second quote.
Frequently asked questions
Can you keep your regular doctor while on hospice?
Yes, if that doctor agrees to work with the hospice team. Your parent's doctor can stay on as the attending physician, the doctor who oversees overall care, while the hospice medical director handles certification. If not, the hospice physician takes that role. Ask before election whether the doctor will stay involved.
What happens if your parent outlives the six month prognosis?
Nothing automatic happens. The hospice rechecks eligibility at each recertification, and if your parent still meets the criteria, the benefit continues into the next period. If your parent no longer meets the criteria, the hospice discharges them, which is called graduating from hospice, and Medicare coverage for other care resumes as before. Your parent can re-elect hospice later if the illness progresses again.
Does hospice provide 24 hour care at home?
Not as a standing service. Routine hospice care at home means scheduled visits, not a nurse in the house around the clock. Continuous home care, a higher level of hospice care with nursing present for most of the day, is only for brief crisis periods when symptoms cannot be controlled otherwise. For longer gaps, ask the hospice team what aide hours and respite days the plan includes, in writing.
Do Medicare Advantage plans cover hospice?
Hospice itself is paid by Original Medicare, even if your parent has a Medicare Advantage plan. The Advantage plan keeps covering care unrelated to the terminal illness, and drug coverage rules follow the plan. Tell both the Advantage plan and the hospice program about the election, so claims for unrelated care do not get sent to the wrong payer.
Your next step is a conversation with your parent's doctor about whether a hospice evaluation is timely, plus a written question to any hospice program you consider about room and board and the two small charges. If you are weighing hospice against other comfort care, read palliative care vs hospice first, then ask the doctor for the evaluation.