In short
To get Medicare hospice, your parent must have Part A, and the hospice doctor and regular doctor, if any, must certify a terminal illness with a life expectancy of six months or less. Your parent must accept comfort care instead of curative treatment and sign a statement choosing hospice. Any illness can qualify, not only cancer.
The three conditions
Medicare hospice eligibility
- Coverage
- Medicare Part A (Hospital Insurance)
- Certification
- The hospice doctor and the regular doctor, if there is one, certify a terminal illness with a life expectancy of six months or less if the illness runs its normal course
- Choice
- Your parent accepts comfort (palliative) care instead of care to cure the illness
- Paperwork
- A signed hospice election statement naming the hospice and the start date
What "six months or less" means
It is a doctor's judgment about the usual course of the illness, not a deadline. Medicare's booklet says hospice can continue past six months as long as the hospice medical director or another hospice doctor recertifies that your parent is still terminally ill.
Not only for cancer
Medicare says plainly that hospice isn't only for people with cancer. Heart failure, lung disease, dementia, kidney failure and other illnesses can all qualify when the doctor certifies the prognosis.
Recertification
Hospice runs in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. A hospice doctor recertifies at the start of each period after the first. After the first six months, Medicare.gov says recertification follows a face-to-face meeting with the hospice doctor or hospice nurse practitioner.
If your parent gets better
If health improves or the illness goes into remission, your parent may no longer qualify. They can also choose to leave hospice at any time. Medicare's booklet says no one should ask your parent to sign a form ending hospice unless they asked to stop. If the hospice says your parent no longer qualifies and you disagree, you can ask for a fast review by the Beneficiary and Family Centered Care Quality Improvement Organization.
Questions families ask
Does my parent need a specific diagnosis for hospice?
No single diagnosis is required. The test is a doctor's certification that the illness is terminal with a life expectancy of six months or less if it runs its normal course.
Can a person with dementia get hospice?
Yes, when the doctor certifies the six-month prognosis. Medicare does not limit hospice to cancer.
Who signs the hospice paperwork?
Your parent signs the election statement, or the person legally allowed to make health decisions for them if your parent can't.
Is there an age requirement for hospice?
Medicare hospice requires Part A, which most people get at 65. Ask other coverage, such as Medicaid or a private plan, how it handles hospice.