Answers

Who is eligible for hospice care under Medicare?

Medicare sets a short list of conditions for hospice, and the paperwork behind them is worth knowing: a certification, an election statement and an addendum.

Arun Verma, co-founder of Triangle · 2026-10-17

This is not clinical evidence and not medical advice. It does not replace your care team. Discuss anything here with your clinician before you act on it.

Who is eligible for hospice care under Medicare?

A person needs Medicare Part A and has to meet all three conditions Medicare.gov lists. The hospice doctor and the person’s regular doctor, if there is one, certify that the person is terminally ill, with a life expectancy of 6 months or less. The person accepts comfort care (palliative care) instead of care to cure the illness and related conditions. And the person signs a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions. The 6 months comes with a qualifier: it applies if the illness runs its normal course, as CMS words it. The care also has to come from a Medicare-certified hospice.

Who certifies that someone is terminally ill?

The hospice doctor and the person’s regular doctor, if there is one. Medicare.gov says only those two can certify it. The CMS Benefit Policy Manual says only a medical doctor or doctor of osteopathy can certify or recertify. A nurse practitioner or physician assistant cannot. The manual’s term for the clinician the person names as having the most significant role in their care is the attending physician, and that can be a nurse practitioner or physician assistant. When it is, the hospice medical director or the physician member of the hospice team certifies instead.

What does choosing comfort care change about coverage?

Once the hospice benefit starts, Medicare stops covering treatment meant to cure the terminal illness and related conditions, and prescription drugs meant to cure it rather than control symptoms or relieve pain. Medicare.gov also lists care from a hospice other than the one the person chose, unless the person changes hospice provider. It lists hospital outpatient, hospital inpatient and ambulance care too, unless the hospice team arranges it or it is unrelated to the terminal illness and related conditions. Room and board at home, in a nursing home or in a hospice inpatient facility is not covered either, though Medicare covers a short-term inpatient or respite stay the hospice team arranges. Health problems unrelated to the terminal illness are still covered. Original Medicare keeps paying for covered services for those, with any deductible and coinsurance that apply. The person has the right to change hospice provider once during each benefit period, Medicare.gov says. The booklet adds that the person always has the right to stop hospice care at any time.

What does the hospice benefit cover?

Once the benefit starts, Original Medicare covers what the person needs for the terminal illness and related conditions, as long as the care comes from a Medicare-approved hospice provider. The person and family work with the hospice team to set up a plan of care. Depending on the illness, that plan can include any or all of these services: doctor services, nursing care, medical equipment such as wheelchairs or walkers, medical supplies, prescription drugs for pain and symptom control, hospice aide and homemaker services, physical and occupational therapy, speech-language pathology, social worker services, dietary counseling, grief and loss counseling for the person and family, short-term inpatient care, short-term respite care, and other services the hospice team recommends that Medicare covers and that are needed to manage the terminal illness and related conditions. Respite care is for when the usual caregiver, such as a family member, needs rest. The booklet says the person can get inpatient respite care in a Medicare-approved facility for up to 5 days each time, and can get respite care more than once, but only on an occasional basis.

How do benefit periods and recertification work?

Hospice is given in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. A person can keep getting hospice past 6 months as long as the hospice medical director or another hospice doctor recertifies that the person is still terminally ill, Medicare.gov says. Medicare’s booklet adds that the person does not need to choose hospice again for each new period. From the third benefit period on, CMS says, recertification must include documentation of a face-to-face encounter with a hospice physician or hospice nurse practitioner. Predicting life expectancy is not always exact. Living longer than expected is not, in itself, cause to end the benefit, according to the Benefit Policy Manual.

What if the person is in a Medicare Advantage Plan?

Original Medicare covers hospice for the terminal illness even if the person stays in a Medicare Advantage Plan or other Medicare health plan. Medicare’s booklet says that if the person belongs to a Medicare Advantage Plan and wants hospice, the plan must help locate a Medicare-approved hospice provider in the area. If the person stays in the plan, covered services for health problems unrelated to the terminal illness can come from Original Medicare or from the plan.

What papers does the hospice keep, and what do they say?

Three papers come up here: the election statement, the written certification and the addendum. The election statement includes, among other things, the hospice providing care, the start date of services and the person’s chosen attending doctor, and it must be completed before any hospice services, Medicare.gov says. Each hospice designs and prints its own, according to the CMS manual. The written certification has to be on file in the person’s hospice record before the hospice bills Medicare, with the clinical information that supports it. It includes, among other things, the 6-month statement, specific clinical findings, the physician’s signature, date and benefit period dates, and a brief narrative from the physician. That narrative has to reflect the person’s individual clinical circumstances, not check boxes or standard language used for all patients. The addendum lists, among other things, the items, services and drugs the hospice has determined are unrelated to the terminal illness, with the reasons. Medicare.gov says the person can ask the hospice for it, and that an updated one follows if coverage changes. CMS says that for elections beginning on or after October 1, 2026, the hospice must give every person who elects hospice one in writing. CMS’s model addendum, updated August 2026, says it has to come within the first 5 days of the election start date. That is a lot of paper to meet at a hard time.

What could you ask the hospice about eligibility and paperwork?

A fair question is which benefit period the person is in and when the next recertification is due, since each period after the first needs one. Another is who the hospice listed as the attending doctor on the election statement. You could also ask whether an addendum has been prepared and what it lists as unrelated to the terminal illness. It is also fair to ask the hospice to point to the line in the election statement or addendum that covers a particular item or service. None of the sources here can say what these rules mean for one person’s situation. That is a question for the hospice team and the person’s doctors.

Sources

• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says the person must have Part A and meet all of three listed conditions to be eligible for hospice care.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov lists as a condition that the hospice doctor and the person’s regular doctor (if the person has one) certify that the person is terminally ill, with a life expectancy of 6 months or less.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov lists as a condition that the person accepts comfort care (palliative care) instead of care to cure the illness and related conditions.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov lists as a condition that the person signs a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
• CMS: Hospice (Medicare fee-for-service providers), Hospice Coverage section (accessed 2026-10-17): CMS says the certification is of a medical prognosis of 6 months or less to live if the illness runs its normal course.
• CMS: Hospice (Medicare fee-for-service providers), Hospice Coverage section (accessed 2026-10-17): CMS lists getting care from a Medicare-certified hospice among the criteria for the hospice benefit under Part A.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says only the person’s hospice doctor and regular doctor (if the person has one) can certify that the person is terminally ill and has a life expectancy of 6 months or less.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 20.1 (Rev. 13664, issued 03-05-26): The manual says no one other than a medical doctor or doctor of osteopathy can certify or re-certify terminal illness, and that nurse practitioners and physician assistants cannot.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 20.1 (Rev. 13664, issued 03-05-26): The manual defines the attending physician as the doctor of medicine or osteopathy, nurse practitioner or physician assistant identified by the individual as having the most significant role in determining and delivering the individual’s medical care, and says that when the attending physician is a nurse practitioner or physician assistant, the hospice medical director or the physician member of the hospice interdisciplinary group certifies the individual as terminally ill.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Medicare won’t cover treatment intended to cure the person’s terminal illness and/or related conditions once the hospice benefit starts.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Medicare won’t cover prescription drugs to cure the illness (rather than for symptom control or pain relief) once the hospice benefit starts.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Medicare won’t cover care from any hospice provider that wasn’t set up by the hospice medical team, and that the person can’t get the same type of hospice care from a different hospice unless the person changes hospice provider.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Medicare won’t cover care received as a hospital outpatient (like in an emergency room), as a hospital inpatient, or ambulance transportation, unless it’s arranged by the hospice team or is unrelated to the terminal illness and related conditions.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Medicare doesn’t cover room and board if the person gets hospice care at home or lives in a nursing home or a hospice inpatient facility, and that if the hospice team determines the person needs short-term inpatient or respite care services that they arrange, Medicare will cover the stay in the facility.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says Original Medicare will still pay for covered benefits for health problems that aren’t part of the terminal illness and related conditions, but the person will owe any deductible and coinsurance amounts that apply.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says the person has the right to change hospice provider once during each benefit period.
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 9: The booklet says the person always has the right to stop hospice care at any time (section “Stopping hospice care”).
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 5: The booklet says once the hospice benefit starts, Original Medicare will cover everything the person needs related to the terminal illness and related conditions, but the care must be from a Medicare-approved hospice provider (section “What Medicare covers”).
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says the person and family will work with the hospice care team to set up the plan of care.
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 5: The booklet says the plan of care the hospice team creates can include any or all of these services, depending on the terminal illness and related conditions: doctor services, nursing care, medical equipment (like wheelchairs or walkers), medical supplies, prescription drugs (for pain and symptom control), hospice aide and homemaker services, physical and occupational therapy, speech-language pathology services, social worker services, dietary counseling, grief and loss counseling for the person and family, short-term inpatient care, short-term respite care, and any other Medicare-covered services needed to manage the terminal illness and related conditions, as recommended by the hospice team.
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 5: The booklet says that if the usual caregiver (like a family member) needs rest, the person can get inpatient respite care in a Medicare-approved facility, for up to 5 days each time, and more than once but only on an occasional basis (section “Respite care”).
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 8: The booklet says hospice care is given in two 90-day benefit periods followed by an unlimited number of 60-day benefit periods (section “How long you can get hospice care”).
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says that after 6 months the person can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that the person is still terminally ill.
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 8: The booklet says that once the hospice benefit starts, the person doesn’t need to “re-choose” hospice care for each new benefit period.
• CMS: Hospice (Medicare fee-for-service providers), Hospice Coverage section (accessed 2026-10-17): CMS says the recertification for a hospice patient’s third benefit period, and every subsequent recertification, must include documentation that a hospice physician or hospice nurse practitioner had a face-to-face encounter with the patient.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 10 (Rev. 246, issued 09-14-18): The manual says predicting of life expectancy is not always exact, and that the fact that a beneficiary lives longer than expected in itself is not cause to terminate benefits.
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 7: The booklet says once the person starts getting hospice care, Original Medicare will cover everything needed related to the terminal illness, even if the person chooses to stay in a Medicare Advantage Plan or other Medicare health plan (section “Hospice care if you’re in a Medicare Advantage Plan or other Medicare health plan”).
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 4: The booklet says that if the person belongs to a Medicare Advantage Plan and wants to start hospice care, the plan must help locate a Medicare-approved hospice provider in the area (section “Finding a hospice provider”).
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 7: The booklet says that if the person stays in the Medicare Advantage Plan, the plan covers services for health problems not related to the terminal illness, and the person has the option to get these services from Original Medicare or from the plan.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says the Hospice Election Statement identifies the hospice providing the care and informs the person about hospice services, including the start date of services and who the person decides to be the attending doctor, and that it must be completed before any hospice services.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 20.2.1.1 (Rev. 10437, issued 11-06-20): The manual says each hospice designs and prints its election statement.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 20.1 (Rev. 13664, issued 03-05-26): The manual says a written certification must be on file in the hospice patient’s record before the hospice submits a claim to Medicare, and clinical information and other documentation that support the medical prognosis must accompany it in the medical record.
• CMS Medicare Benefit Policy Manual, Chapter 9, section 20.1 (Rev. 13664, issued 03-05-26): The manual says a complete written certification includes a statement of a life expectancy of 6 months or less if the terminal illness runs its normal course, specific clinical findings and other documentation, the physician’s signature, the date signed and the benefit period dates covered, and the physician’s brief narrative; the narrative must reflect the patient’s individual clinical circumstances and cannot contain check boxes or standard language used for all patients.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says the person can ask the hospice provider for a list of items, services and drugs the hospice has determined aren’t related to the terminal illness and related conditions, and that the list must include why they made that determination.
• Medicare.gov: Hospice care coverage (accessed 2026-10-17): Medicare.gov says that if coverage changes, the hospice provider will give an updated addendum.
• CMS: Hospice News & Announcements, “Initial Implementation of Mandatory Hospice Election Statement Addendum” (accessed 2026-10-17): CMS’s Hospice News & Announcements page says that starting October 1, 2026, hospices must give every patient an election statement addendum, in writing, for each hospice election, telling the patient about items, services and drugs the hospice will not cover because they’re unrelated to the patient’s terminal illness.
• CMS: Model Hospice Election Statement Addendum, “Patient Notification of Hospice Non-Covered Items, Services, and Drugs” (updated August 2026), pp. 1-2: CMS’s model addendum (updated August 2026) says that for hospice elections beginning on or after October 1, 2026, the hospice must provide the addendum in writing within the first 5 days of the election start date (p. 1), and that “date furnished” means receipt in writing within 5 days of the effective date of election (p. 2).
• Medicare.gov: Medicare Hospice Benefits booklet (CMS Product No. 02154, March 2026), p. 8: The booklet says that at the start of each benefit period after the first 90-day period, the hospice medical director or other hospice doctor must recertify that the person is terminally ill so the person can continue to get hospice care.

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