Important: The hospice program you choose must be Medicare-approved to get Medicare payment.
If you have Medicare Part A (Hospital Insurance) AND meet these conditions, you can get hospice care:
Hospice care is given in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical director and your doctor must recertify that you’re terminally ill, (with a life expectancy of 6 months or less), so you can continue to get hospice care. You have the right to change providers once during each benefit period.
You always have the right to stop hospice care at any time for any reason. If you stop your hospice care, you’ll get the type of Medicare coverage you had before you chose a hospice program (like treatment to cure terminal illness.). If you’re eligible, you can go back to hospice care at any time.
Hospice care is usually given in your home. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:
Important: Once you choose hospice care, your hospice benefit should generally cover everything you need. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is very rare.
All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you were previously in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.
Note: If your Medicare Advantage Plan or other Medicare health plan covers extra services that Original Medicare doesn’t cover (like dental and vision benefits), your plan will continue to cover these extra services while you’re in hospice care (as long as you continue to pay your premium).
People with Medicare have certain guaranteed rights. If your hospice program or doctor believes that you’re no longer eligible for hospice care because your condition has improved—and you don’t agree—you have the right to ask for a review of your case.
Your hospice should give you a notice that explains your right to an expedited (fast) review by an independent reviewer hired by Medicare, called a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). If you don’t get this notice, ask for it. This notice lists your BFCC-QIO’s contact information and explains your rights.
You can also visit Medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your BFCC-QIO. TTY users should call 1-877-486-2048.
Note: If you pay out-of-pocket for an item or service your doctor ordered, but the hospice refuses to give it to you, you can file a claim with Medicare. If your claim is denied, you can file an appeal.