Hospice care is covered under Medicare Part A (hospital insurance). It is one of the core benefits of Part A, alongside hospital stays and skilled nursing facility care. However, Part B plays a smaller but important role: if your regular doctor continues to oversee your care and is not employed by or paid by the hospice agency, their professional services related to your terminal illness are billed through Part B.
How the Part A Hospice Benefit Works
When you elect hospice, Medicare Part A covers the vast majority of your care. This includes nursing visits, medical social services, counseling, medical equipment like hospital beds and wheelchairs, prescription drugs for symptom control and pain relief, aide services, and short-term inpatient care when symptoms can’t be managed at home. The hospice agency receives a daily payment rate from Medicare to coordinate and deliver all of these services.
To qualify, three conditions must be met. Your hospice doctor and your regular doctor (if you have one) must certify that you have a terminal illness with a life expectancy of six months or less. You must accept comfort-focused care instead of treatments aimed at curing your illness. And you must sign an election statement choosing hospice care, which means you waive most other Medicare-covered treatments for your terminal condition and related conditions while the election is in effect.
Where Part B Fits In
Once you’re enrolled in hospice, you give up Part B coverage for most services related to your terminal illness. There is one key exception: your independent attending physician. If your regular doctor is not employed by or compensated by the hospice agency, their professional services for managing your terminal condition are billed to Medicare Part B. Your doctor uses a special billing modifier to indicate they are independent of the hospice provider.
This distinction matters financially. Services from an independent attending physician are paid through Part B and are not counted against the hospice’s overall payment cap. You would still owe your normal Part B cost-sharing (typically 20% after the deductible) for those visits. By contrast, if the attending physician works for or is contracted by the hospice, their services are billed under Part A as part of the hospice benefit, and you pay nothing extra.
When an independent attending physician orders something that has both a professional and technical component, like an X-ray, the professional interpretation goes through Part B. The technical side (the actual imaging) is the hospice agency’s responsibility to arrange and pay for.
What Part A Covers for Unrelated Conditions
Electing hospice only affects coverage for your terminal illness and conditions related to it. If you break your arm or need treatment for a completely unrelated health problem, Medicare Part A and Part B continue to cover those services the same way they normally would. You keep your regular Medicare benefits for everything outside the scope of your terminal diagnosis.
Certification and Benefit Periods
Hospice coverage is organized into benefit periods. The first period lasts 90 days, followed by a second 90-day period, and then unlimited 60-day periods after that. For the initial 90-day period, two physicians must certify the terminal prognosis: one from the hospice (typically the medical director) and your attending physician if you have one. For all subsequent periods, only a hospice physician needs to recertify, which requires a face-to-face visit with a hospice doctor or nurse practitioner confirming the illness is still terminal.
There is no hard cutoff at six months. If you are still terminally ill after the initial prognosis, hospice care continues as long as recertification happens at each benefit period. Some patients remain on hospice for well over a year.
Costs You May Still Owe
Under the Part A hospice benefit, most services come at no cost to you. There are two exceptions. You may owe a small copayment for prescription drugs used for pain and symptom management, typically no more than $5 per medication. You may also owe a copayment for inpatient respite care, which is short-term care in a facility designed to give your primary caregiver a break. Medicare caps respite stays at five consecutive days per episode.
One important gap: the hospice benefit does not cover room and board. If you live in a nursing home or assisted living facility, Medicare will not pay your daily room charges just because you are on hospice. You or your family remain responsible for those costs. Medicare does cover your stay if the hospice team determines you need short-term inpatient care for symptom management or respite, but that is arranged through the hospice and is temporary.
Leaving Hospice and Returning to Standard Medicare
You can revoke your hospice election at any time by signing a written statement. Once you do, your standard Medicare Part A and Part B benefits resume immediately for all conditions, including the one that was your terminal diagnosis. You can also re-elect hospice later if your condition warrants it. The decision is not permanent in either direction, and choosing hospice does not close off your options going forward.