Medicare Hospice Coverage: Who Qualifies, What It Pays, and What Families Pay in Florida
Six months or less. That's the prognosis a hospice doctor (and your own doctor, if you have one) must put in writing before Medicare Part A pays for hospice. Once it does, Original Medicare covers nearly everything tied to the terminal illness: nurses, the hospice doctor, aides, equipment, comfort medications, counseling for the family. The patient's share is small by design: up to $5 per prescription for pain and symptom drugs, and 5% of Medicare's rate for respite stays.
What families hear too late is what hospice doesn't pay for, and what the patient signs away by choosing it. Room and board in a nursing home is the big one. Below are the federal rules, plus the Florida pieces: checking a hospice, when Florida Medicaid can pick up the nursing home bill, and where to get unbiased help.
Source: Medicare.gov, Hospice care; Medicare Hospice Benefits (CMS Product No. 02154, March 2026); 42 CFR 418.22 and 418.400.
Who qualifies
The federal rule is short. Under 42 CFR 418.20, you have to be entitled to Part A and certified as terminally ill. Section 418.22 spells out what that certification means: the doctor's clinical judgment that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course," backed by a written narrative of the clinical findings.
For the first benefit period, two signatures are needed: the hospice medical director (or the hospice's physician designee or physician team member) and your own attending doctor, if you have one. After that, the hospice doctor alone recertifies.
Medicare.gov adds the two conditions that are really about choice: you accept comfort care (palliative care) instead of care to cure the illness, and you sign a statement choosing hospice instead of other Medicare-covered treatment for the terminal illness and related conditions.
Hospice isn't only for cancer; the CMS booklet says so directly. Six months is a prognosis, not a time limit: people who live longer keep hospice as long as the hospice doctor recertifies. And you can talk before you decide. Medicare covers a one-time consultation with a hospice medical director or hospice doctor about care options and pain management, even if you don't go on to choose hospice.
What you sign, and what you give up
Hospice starts with a signed election statement. Under 42 CFR 418.24 it names the hospice and your attending doctor, confirms you understand hospice is palliative rather than curative, explains your cost sharing, and gives contact information for the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), the independent reviewer you can call if you disagree with the hospice. A representative can sign for a patient who can't.
What the signature waives: while the election lasts, Medicare won't pay for services related to the terminal illness except through the hospice you picked (or care it arranges) and your attending doctor. In practice:
- No Medicare payment for treatment aimed at curing the terminal illness, including drugs meant to cure it rather than relieve symptoms.
- No Medicare payment for hospice-type care from a different hospice, unless you formally switch.
- Hospital stays, ER visits and ambulance rides for the terminal illness need to go through the hospice. Medicare.gov's warning is blunt: if the hospice didn't arrange your hospital stay, "you might have to pay for the entire cost."
What you keep: Original Medicare still pays for health problems unrelated to the terminal illness, with the usual deductibles and coinsurance (42 CFR 418.402). Someone in hospice for lung cancer who breaks a wrist still has Part B for the fracture, if the hospice agrees the fracture is unrelated.
My advice: read that list with the hospice nurse at the kitchen table, not later. If a medication your mother has taken for years is on it as "unrelated," ask why, and ask whether Part D will pick it up. That's where surprise pharmacy bills come from.
What hospice covers and what it doesn't
The covered list is in 42 CFR 418.202 and in plainer language on Medicare.gov. A hospice nurse and doctor are on call 24 hours a day, 7 days a week.
| Covered when it's in the plan of care | Not covered by the hospice benefit |
|---|---|
| Doctor services and nursing care | Treatment intended to cure the terminal illness |
| Medical equipment (like wheelchairs or walkers) and supplies (bandages, catheters) | Prescription drugs to cure the illness, or drugs unrelated to it (Part D may cover those) |
| Drugs for pain and symptom control | Care from a hospice or provider the hospice team didn't arrange |
| Hospice aide and homemaker services | Room and board at home, in a nursing home or in a hospice inpatient facility (short-term stays the hospice arranges are the exception) |
| Physical, occupational and speech-language therapy | ER, inpatient hospital care or ambulance for the terminal illness unless the hospice arranged it |
| Social work, dietary counseling, spiritual and grief counseling for patient and family | |
| Short-term inpatient care for pain and symptom management | |
| Inpatient respite care, up to 5 days at a time |
Source: Medicare.gov, Hospice care; Medicare Hospice Benefits booklet, pp. 5-6; 42 CFR 418.202.
Room and board is the line that surprises people. Hospice sends its team into the nursing home, but Medicare doesn't pay the nursing home's daily charge for living there, except during a short-term inpatient or respite stay the hospice arranges. It's also not the skilled nursing benefit; for how that one works, see Medicare skilled nursing facility coverage.
If you pay out of pocket for something your doctor ordered after the hospice refused to provide it, the booklet says you can file an appeal with Medicare, and the State Health Insurance Assistance Program (in Florida, SHINE) can help you do it.
The four levels of hospice care
Medicare pays hospices at one of four daily levels (42 CFR 418.302). The hospice team picks the level, but knowing they exist helps you ask for the right one.
| Level | Where | When it's used |
|---|---|---|
| Routine home care | Wherever the patient lives: home, assisted living, nursing home | The default. Scheduled visits from the team, on-call help around the clock |
| Continuous home care | At home | A crisis: predominantly nursing care, for as much as 24 hours a day, to keep the patient at home (at least 8 hours in a day to count) |
| General inpatient care | Hospice inpatient unit, hospital or SNF | Pain or symptoms that can't be managed in another setting |
| Inpatient respite care | Medicare-approved hospice unit, hospital or nursing home | To give the family caregiver a rest; no more than 5 consecutive days at a time, on an occasional basis |
Source: 42 CFR 418.302(b) and 418.204; MedPAC, March 2026 Report, ch. 10.
Routine home care was 98.8% of Medicare-covered hospice days in 2024, per MedPAC. If your father is in distress at 2 a.m. and the visits aren't keeping up, ask the hospice nurse directly whether he qualifies for continuous home care or general inpatient care. The rules allow both.
What you pay
There's no deductible for hospice. The CMS booklet lists what you do pay: your Part A and Part B premiums, a copayment of up to $5 per prescription for outpatient pain and symptom drugs, and 5% of the Medicare-approved amount for inpatient respite care.
The respite coinsurance has a ceiling. Under 42 CFR 418.400(b), it can't exceed the Part A inpatient hospital deductible for the year your hospice coinsurance period began. For a period that began in 2026, that's $1,736 (CMS 2026 fact sheet). A hospice coinsurance period starts the day the election takes effect and ends only after 14 consecutive days without an election in effect.
| Cost | What you pay under Original Medicare |
|---|---|
| Hospice care related to the terminal illness | Nothing (Medicare-approved hospice) |
| Outpatient drugs for pain and symptom control | Up to $5 per prescription |
| Inpatient respite care | 5% of Medicare's daily payment, capped at the Part A deductible ($1,736 for a period beginning in 2026) |
| Room and board in a nursing home or other facility where you live | All of it, unless another payer (such as Medicaid) covers it |
| Care for unrelated conditions | Usual Medicare deductibles and coinsurance |
| Part A and Part B premiums | Still due |
Source: Medicare Hospice Benefits booklet, p. 8; 42 CFR 418.400 and 418.402; CMS 2026 Parts A and B fact sheet; Medicare.gov, Hospice care.
Benefit periods: 90, 90, then 60 at a time
Hospice runs in benefit periods (42 CFR 418.21): an initial 90 days, a second 90 days, then an unlimited number of 60-day periods. They're used in that order, and they aren't the same as the Part A hospital "benefit period."
You don't re-sign the election each time. At each boundary the hospice doctor recertifies. Starting with the third period, a hospice doctor or hospice nurse practitioner must also see the patient face to face within the 30 days before recertification, and again before every period after that (42 CFR 418.22(a)(4)).
| Period | Days | To continue |
|---|---|---|
| 1st | 90 (days 1-90) | Hospice doctor plus your attending doctor certify |
| 2nd | 90 (days 91-180) | Hospice doctor recertifies |
| 3rd | 60 (days 181-240) | Face-to-face visit, then recertification |
| 4th | 60 (days 241-300) | Face-to-face visit, then recertification |
| 5th and later | 60 each, no limit | Face-to-face visit before each |
Source: 42 CFR 418.21 and 418.22; Medicare Hospice Benefits booklet, p. 8. Day counts computed by Maru Insurance.
Through December 31, 2027, that visit can be done by two-way audio and video when it's only for recertification, with exceptions that started January 31, 2026 (for example, a hospice under enhanced CMS oversight can't use video for it).
Stopping, switching, or being discharged
These are three different things, and they have different consequences.
Revoking (your choice). You can stop hospice at any time (42 CFR 418.28). You sign a statement with the date it takes effect, which can't be earlier than the day you sign. Your regular Medicare coverage for the terminal illness comes back, and you can elect hospice again later if you still qualify. The catch: revoking gives up whatever is left of the current benefit period. If you revoke on day 40 of the first 90-day period, you come back into the second period, not the remaining 50 days.
Medicare.gov is emphatic on one point: nobody from the hospice should ask you to sign revocation forms when you start hospice. "Stopping hospice care is a choice only you can make," and you shouldn't sign or date anything until the actual day you want care to stop. If someone presents a pre-dated revocation form, say no and call 1-800-MEDICARE.
Switching hospices. You can change hospice providers once in each benefit period, and it isn't a revocation (42 CFR 418.30). You file a statement with both hospices naming the effective date. If the problem is the provider rather than hospice itself, switching is usually the better first move.
Live discharge (the hospice's decision). A hospice may discharge a patient who moves out of its service area, who is no longer terminally ill, or, after documented efforts to resolve it, for cause (42 CFR 418.26). Discharge needs a physician's order and should involve the attending doctor. If the hospice says the patient has improved and no longer qualifies and you disagree, the CMS booklet says you have the right to a fast review by the BFCC-QIO; the hospice should give you a notice explaining it, and if it doesn't, ask for one.
Live discharges aren't rare: MedPAC reports 19.1% of hospice discharges in 2024 were live, and one in ten hospices with more than 30 discharges had live-discharge rates of 56% or more in 2023. MedPAC flags high rates as a possible sign of poor quality or of admitting patients who weren't eligible.
If you're in a Medicare Advantage plan
Original Medicare pays for hospice even if you're in a Medicare Advantage plan. That's how it works today and it's spelled out on Medicare.gov: once the hospice benefit starts, "Original Medicare will cover everything you need related to your terminal illness... even if you stay in your plan."
From 2021 through 2024, CMS ran a test (the hospice benefit component of the Value-Based Insurance Design model) in which some participating plans covered hospice themselves. CMS ended that test at 11:59 p.m. on December 31, 2024. Older material describing hospice "carved in" to an Advantage plan is out of date.
What the plan still does if you stay in it (and keep paying any plan premium):
- It must help you find a Medicare-approved hospice in your area.
- It can cover services for health problems unrelated to the terminal illness, and extra benefits Original Medicare doesn't cover, like dental and vision.
- If the plan includes drug coverage, it covers drugs unrelated to the terminal illness.
- If you leave hospice, Medicare.gov says your plan starts again on the first day of the following month. MedPAC notes that Original Medicare pays for Part A and B services until then.
For unrelated care, what you pay depends on the plan's rules; check its Evidence of Coverage or ask SHINE.
What Medigap pays
Medigap plans are standardized by letter, so the hospice benefit is the same for a given letter regardless of who sells it. Every standardized plan pays at least part of the Part A hospice coinsurance or copayment: that's the $5 drug copays and the 5% respite coinsurance. The CMS booklet adds that a Medigap policy also helps with costs for problems that aren't part of the terminal illness.
| Plan letter | Part A hospice coinsurance or copayment |
|---|---|
| A, B, C, D, F, G, M, N | 100% |
| K | 50% (2026 out-of-pocket limit $8,000) |
| L | 75% (2026 out-of-pocket limit $4,000) |
Source: Medicare.gov, Compare Medigap plan benefits; CMS, Choosing a Medigap Policy (Product No. 02110, March 2026). Plans C and F are only available to people eligible for Medicare before January 1, 2020.
For Florida's Medigap rules, see Florida Medigap rules and our Medicare Supplement insurance in Florida page.
Florida: checking a hospice, Medicaid and SHINE
Checking a hospice. Medicare covers hospice only from a Medicare-approved provider. Two places to look:
- Medicare Care Compare lists Medicare-approved hospices by ZIP code and compares them on quality measures.
- FloridaHealthFinder, run by Florida's Agency for Health Care Administration (AHCA), lets you compare and locate licensed hospices, look up inspection reports and final orders, and file a complaint.
Florida licenses hospices under Chapter 400, Part IV of the Florida Statutes and Chapter 59A-38 of the Florida Administrative Code, and state law requires a certificate of need from AHCA before a new hospice can even apply for a license (AHCA hospice licensure). Questions I'd ask any hospice from Miami-Dade to the Panhandle: How fast does a nurse come after a night call? Which inpatient units and nursing homes do you use for respite? Does your service area cover where we'll live?
That last one matters for snowbirds: a hospice can discharge a patient who moves out of its service area, so talk to the hospice before taking a parent north for the summer. See Medicare for Florida snowbirds.
Florida Medicaid and room and board. This is the piece that can close the nursing home gap. Florida Medicaid's hospice coverage includes nursing facility room and board, and AHCA lists hospice as one of the minimum covered services for all Managed Medical Assistance and Long-Term Care plans serving Medicaid enrollees. The patient has to be on Florida Medicaid, certified terminally ill and have elected hospice under the same federal rules (the program's rule is Rule 59G-4.140, F.A.C.). Eligibility depends on income and assets; how Medicare and Florida Medicaid work together is covered in Florida Medicaid and Medicare.
Unbiased help. SHINE (Serving Health Insurance Needs of Elders), run by the Florida Department of Elder Affairs with local Area Agencies on Aging, offers unbiased, confidential Medicare counseling at no charge: 1-800-96-ELDER (1-800-963-5337), or start at floridashine.org. For quality-of-care complaints, the CMS booklet points to the state survey agency or the BFCC-QIO; you can also reach the QIO through 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). The wider picture of Parts A through D is on our Medicare in Florida page.
How hospice is used: the national numbers
Some context from the Medicare Payment Advisory Commission's March 2026 report. In 2024, more than 1.8 million Medicare beneficiaries got hospice care from about 6,700 providers, and Medicare spent $28.3 billion on it. More than half of Medicare beneficiaries who died that year used hospice, a record share.
Source: MedPAC, March 2026 Report to the Congress, Table 10-2. Years shown as reported; 2011 to 2018 and 2020 to 2021 not shown in the table.
Show the numbers
| Used hospice | |
|---|---|
| 2010 | 43.8% |
| 2019 | 51.6% |
| 2022 | 49.1% |
| 2023 | 51.7% |
| 2024 | 52.9% |
Source: MedPAC, March 2026 Report to the Congress, Table 10-2.
Show the numbers
| Age | Share who used hospice |
|---|---|
| <65 | 29.8% |
| 65-74 | 41.1% |
| 75-84 | 52.9% |
| 85+ | 65.2% |
The number I'd want every family to see: the median lifetime hospice stay among decedents in 2024 was 19 days, and more than a quarter enrolled only in the last week of life. The average was 99.6 days, pulled up by a minority of very long stays. MedPAC calls very short stays an opportunity for quality improvement.
My read: hospice decisions get made late, often in a hospital hallway. If a doctor has raised the six-month question, the one-time hospice consultation is a low-stakes way to learn what's available before a crisis forces the choice.
Questions
Does Medicare cover hospice care?
Yes. Medicare Part A covers hospice when a hospice doctor and your regular doctor (if you have one) certify a life expectancy of 6 months or less, you accept comfort care instead of curative treatment, and you sign an election statement. There's no deductible.
How long will Medicare pay for hospice?
There's no fixed limit. Hospice runs in two 90-day benefit periods followed by an unlimited number of 60-day periods, as long as the hospice doctor recertifies that the patient is terminally ill. A face-to-face visit is required before the third period and each one after.
Does Medicare pay for room and board in a nursing home during hospice?
No. The hospice benefit doesn't cover room and board at home, in a nursing home or in a hospice inpatient facility, except for short-term inpatient or respite stays the hospice arranges. In Florida, Medicaid's hospice coverage includes nursing facility room and board for people on Medicaid.
What do you pay for hospice under Medicare?
Up to $5 per prescription for outpatient pain and symptom drugs and 5% of the Medicare-approved amount for inpatient respite care, capped at the Part A inpatient deductible. You also keep paying your Part A and Part B premiums.
Can you leave hospice and go back?
Yes. You can revoke hospice at any time and your regular Medicare coverage resumes, but you give up the rest of that benefit period. If you still qualify, you can elect hospice again later. You can also change hospice providers once in each benefit period without revoking.
Federal Medicare rules, Florida law, your plan's own documents and the hospice's plan of care control what's covered. Confirm your situation with 1-800-MEDICARE, SHINE or a licensed agent, and talk to an attorney for legal questions.
Sources
- Medicare.gov: Hospice care
- CMS: Medicare Hospice Benefits (Product No. 02154, March 2026)
- eCFR: 42 CFR 418.20, eligibility requirements
- eCFR: 42 CFR 418.21, duration of hospice care coverage (election periods)
- eCFR: 42 CFR 418.22, certification of terminal illness
- eCFR: 42 CFR 418.24, election of hospice care
- eCFR: 42 CFR 418.26, discharge from hospice care
- eCFR: 42 CFR 418.28, revoking the election of hospice care
- eCFR: 42 CFR 418.30, change of the designated hospice
- eCFR: 42 CFR 418.202, covered services
- eCFR: 42 CFR 418.204, special coverage requirements
- eCFR: 42 CFR 418.302, payment procedures for hospice care
- eCFR: 42 CFR 418.400, individual liability for coinsurance
- eCFR: 42 CFR 418.402, liability for services not considered hospice care
- CMS: FY 2027 Hospice Wage Index and Payment Rate Update final rule fact sheet (July 30, 2026)
- CMS: 2026 Medicare Parts A and B premiums and deductibles fact sheet
- CMS Innovation Center: VBID Model Hospice Benefit Component overview
- MedPAC: March 2026 Report to the Congress, Chapter 10, Hospice services
- Medicare.gov: Compare Medigap plan benefits
- Medicare.gov: Care Compare (hospice)
- Florida AHCA: FloridaHealthFinder
- Florida AHCA: Hospice licensure
- Florida AHCA: Hospice licensure FAQ
- Florida AHCA: Florida Medicaid hospice services
- Florida Administrative Code: Rule 59G-4.140, Hospice Services
- SHINE, Florida Department of Elder Affairs
This article is for general educational purposes only and is not legal, tax or insurance advice. Coverage depends on the actual policy, its terms, conditions and exclusions, and state law. Maru Insurance · WA License (WAOIC) #1365574 · FL License #G363233 · NPN 22261820.