What Is the Medicare Hospice Benefit and Who Qualifies?
By CRYSTAL BAI •
The short answer: The Medicare Hospice Benefit covers all hospice services — medical care, medications, equipment, nursing, social work, chaplaincy, and grief support — for Medicare beneficiaries who are terminally ill with a prognosis of six months or less if the illness runs its normal course, and who elect comfort-focused care over curative treatment.
What Does the Medicare Hospice Benefit Cover?
Under Medicare Part A, the hospice benefit covers:
- Physician services related to the terminal diagnosis
- Nursing care — registered nurses visit regularly; on-call 24/7
- Medical equipment — hospital bed, wheelchair, oxygen, bedside commode
- Medications for pain, comfort, and symptom management related to the terminal diagnosis
- Home health aide — assistance with bathing, dressing, personal care
- Social worker — counseling and resource coordination
- Chaplain or spiritual care — for patient and family
- Volunteer services — companionship, respite for caregivers
- Bereavement counseling — for the family for 13 months after the death
- Inpatient respite care — up to 5 days in a facility to give caregivers a break
- Short-term inpatient care — for uncontrolled symptoms
Who Qualifies for the Medicare Hospice Benefit?
To qualify, a patient must:
- Be enrolled in Medicare Part A
- Have a terminal illness with a physician-certified prognosis of 6 months or less if the illness runs its normal course
- Choose comfort-focused care (elect hospice) and forgo curative treatment for the terminal diagnosis
- Receive care from a Medicare-certified hospice program
How Is Hospice Care Organized Under Medicare?
The Medicare Hospice Benefit is organized into benefit periods:
| Period | Duration |
|---|---|
| First benefit period | 90 days |
| Second benefit period | 90 days |
| Subsequent periods | 60 days each (unlimited) |
At the end of each period, two physicians must re-certify that the patient still has a prognosis of 6 months or less. Patients can remain on hospice beyond 6 months if they continue to qualify.
What Is Not Covered?
The Medicare Hospice Benefit does NOT cover:
- Curative treatment for the terminal diagnosis (e.g., chemotherapy to cure cancer)
- Medications for conditions unrelated to the terminal illness (these remain covered under Medicare Part D)
- Room and board in a nursing home or assisted living (these are separate costs)
- Death doula services (not yet reimbursed by Medicare)
The Problem: Most People Wait Too Long
The median hospice length of stay in the U.S. is approximately 18 days — far shorter than the ideal 3–6 months that research shows benefits families most. Many families are not referred to hospice until the final days or weeks of life, missing months of comprehensive support they were entitled to.