Hospice care is a specialized form of care designed for individuals with a life-limiting illness, focusing on comfort and quality of life rather than curative treatments. This care supports the patient’s physical, emotional, and spiritual well-being, and is most often delivered in the patient’s home or a homelike setting. Yes, a hospice patient can be admitted to the hospital, but this decision fundamentally changes the status of their care and how it is paid for. Seeking acute care signals a shift in the immediate goal of treatment, which has significant administrative and financial consequences.
Hospice Care vs. Acute Care Goals
Hospice care and acute hospital care operate with fundamentally different objectives. Hospice care provides palliative treatment, meaning it manages pain and other symptoms to maximize comfort and dignity during the final phases of life. The intent is not to find a cure or prolong life through aggressive medical intervention. This care is typically provided by an interdisciplinary team wherever the patient resides.
Acute hospital care, conversely, is characterized by aggressive intervention and a curative or stabilization intent. It is designed for short-term, intensive treatment of severe illnesses, injuries, or sudden exacerbations of chronic conditions. When a hospice patient is admitted to a hospital, the focus temporarily shifts from comfort management to the immediate goal of diagnostic testing, stabilization, or intervention.
When Hospitalization Becomes Necessary
A hospice patient may require acute hospitalization when their needs exceed the capabilities of the current hospice setting or team. The most common reason is the sudden onset of severe, unmanageable symptoms, such as uncontrolled pain, intractable nausea, or respiratory distress that cannot be stabilized with home-based interventions. For example, a severe pathological fracture may require specialized, short-term radiation therapy for pain relief, which is only available in a hospital setting.
Hospitalization can also become necessary for conditions entirely unrelated to the patient’s terminal diagnosis. A sudden event like a traumatic injury, such as a fall resulting in a broken bone, or an acute, non-terminal infection requires immediate attention. The hospital stay is intended to address the acute condition with the goal of quickly returning the patient to their established hospice environment. The hospice team should be contacted before any hospitalization to help coordinate care.
How Hospitalization Affects Hospice Enrollment
A patient’s enrollment status under the Medicare Hospice Benefit is directly affected by the reason for their hospital admission.
General Inpatient Care (GIP)
If the hospitalization is for symptom management related to the terminal illness, the hospice team may arrange for the patient to receive General Inpatient Care (GIP) at a contracted hospital unit. GIP is one of the four levels of hospice care intended for short-term management of acute symptoms and is fully covered by the hospice benefit.
Revocation
If the patient seeks curative treatment for the terminal illness or is admitted to a non-contracted facility, a change in enrollment status is usually required. The patient must choose between a formal “revocation” or a “suspension” of their hospice benefit. Revocation is a formal, written statement where the patient chooses to end hospice benefits entirely, which is necessary if they decide to pursue curative treatments. The patient must sign a document stating they no longer wish to receive Medicare hospice coverage.
Suspension
If the hospital stay is for a condition unrelated to the terminal illness, or if the patient intends to return to hospice care, the hospice benefit is typically “suspended.” While this is a common practice, Medicare rules dictate that the patient is discharged from hospice care for cause if they receive treatment in a non-contracted facility for an unrelated condition. The hospice provider is then responsible for coordinating the patient’s return to hospice care when discharged from the hospital. The patient has the right to re-elect the hospice benefit at any time, provided they still meet the eligibility criteria.
Paying for Hospital Stays Under Hospice Care
The financial responsibility for a hospital stay depends entirely on the patient’s enrollment status and the nature of the treatment received. If the hospice benefit is formally revoked, or if the patient is discharged from hospice care, their primary insurance—such as Medicare Part A or a private plan—resumes responsibility for the hospital bill. This means the patient will be responsible for any applicable deductibles, co-pays, or co-insurance charges that are part of their standard insurance plan.
If the patient is hospitalized for a condition unrelated to the terminal diagnosis, their non-hospice insurance coverage, such as Medicare Part A and B, will cover the necessary treatments, subject to the usual cost-sharing rules. Crucially, the hospice benefit will not pay for the hospital stay or treatments related to the terminal illness during this period of suspension or revocation. If the hospice team arranges a General Inpatient Care stay, the hospice benefit covers 100% of the care, with no deductible or co-payment required from the patient.