Medicare Hospice Coverage: What You Pay in 2026

Opening answer

Medicare hospice coverage is a Part A (Hospital Insurance) benefit. Original Medicare pays for hospice when you have Part A, your hospice doctor and your regular doctor (if you have one) certify that you are terminally ill with a life expectancy of 6 months or less if the illness runs its normal course, you accept comfort care instead of care meant to cure that illness and related conditions, and you sign a statement choosing a Medicare-approved hospice.[1]

You pay nothing for covered hospice care from that provider, and there is no hospice deductible.[1][3] Families may still owe a copayment of up to $5 for each outpatient prescription used for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care. That respite coinsurance cannot exceed the Part A inpatient hospital deductible, which is $1,736 in 2026.[1][4]

Those rules are federal. They apply to a family in Greensboro or anywhere else in North Carolina the same way they apply in every other state. Hospice is comfort-focused care for a terminal illness. It is not payment for nursing-home room and board, and it is not Medicare home health or long-term custodial care.

Who qualifies, and what the 6-month prognosis means

You must have Medicare Part A. Then three conditions have to be true together:

1. Certification of terminal illness. Your hospice doctor and your regular doctor (if you have one) certify that you are terminally ill, with a medical prognosis of 6 months or less to live if the illness runs its normal course.[1][2]
2. You accept palliative (comfort) care instead of treatment intended to cure the terminal illness and related conditions.[1]
3. You sign a Hospice Election Statement choosing hospice instead of other Medicare-covered treatments for that illness and related conditions.[1]

Only those doctors can make the certification.[1] Medicare is not limited to one diagnosis. The official hospice booklet states that hospice is not only for people with cancer.[3]

The 6-month figure is a medical prognosis, not a calendar deadline. If you live longer than 6 months, you can still receive hospice as long as the hospice medical director or another hospice doctor recertifies that you remain terminally ill.[3] Coverage is organized in benefit periods: two 90-day periods, then an unlimited number of 60-day periods.[1][2] At the start of each period after the first 90 days, a hospice doctor must recertify the prognosis so care can continue.[3]

Starting with the third benefit period, the Centers for Medicare & Medicaid Services (CMS) also requires a face-to-face encounter with a hospice physician or hospice nurse practitioner. That visit must document clinical findings that support a life expectancy of 6 months or less.[2]

You have the right to change your hospice provider once during each benefit period.[1] Medicare only pays if the hospice is Medicare-approved. Medicare.gov's Care Compare tool lists approved hospices. If you belong to a Medicare Advantage Plan, the plan must help you find one in your area.[3]

Electing hospice, and the right to stop

Before any hospice services start, you (or your representative) sign a Hospice Election Statement. That document names the hospice providing care, the start date, and the attending doctor you choose.[1] CMS describes the legal effect in plain terms: you elect the benefit and waive Medicare payment for the terminal illness and related conditions except through the hospice.[2] You can still see your regular doctor, nurse practitioner, or physician assistant if you name that person as the attending medical professional who helps supervise hospice care.[1][3]

You can ask the hospice for a written list of items, services, and drugs it has decided are not related to the terminal illness, including why. The provider must give you that list within 3 to 5 days of your request, depending on when you asked, and share it with your other providers or with Medicare if asked.[1]

Choosing hospice is a care decision, not a one-way door. You can stop hospice at any time. If you do, the hospice will ask you to sign a form that includes the date care will end. Medicare's booklet is clear that no one should ask you to sign stop-care forms you did not request, and that you should not sign or date them until the date you actually want care to end.[3] If you still meet the rules, you can return to hospice later.[3][7]

Before you enroll, you can get a one-time consultation with a hospice medical director or hospice doctor to talk through care options and how to manage pain and other symptoms. You can have that conversation even if you later decide not to elect hospice.[3]

What Part A covers once you elect

Once the benefit starts, Original Medicare covers care related to the terminal illness and related conditions through the hospice you chose, even if you remain in a Medicare Advantage Plan.[3] You and your family work with the hospice team on an individualized written plan of care.[2] Depending on that plan, covered items and services include:

• Doctor services, including a hospice physician and, if you choose, your attending clinician
• Nursing care
• Medical equipment needed to relieve pain or manage the terminal condition (for example, a wheelchair or walker)
• Medical supplies (for example, bandages and catheters)
• Prescription drugs for pain and symptom control
• Hospice aide and homemaker services
• Physical therapy, occupational therapy, and speech-language pathology services
• Medical social services
• Dietary counseling
• Spiritual counseling
• Grief and loss counseling for you and your family, including after a death
• Short-term inpatient care for pain and symptom management
• Short-term respite care
• Other reasonable and necessary Medicare-covered services that belong in the plan of care[2][3]

A hospice nurse and doctor are on call 24 hours a day, 7 days a week.[3] Care is usually given where you live: a private home, an assisted living facility, or a nursing home. If you meet certain conditions, you can also receive care in an inpatient hospice facility. If the team decides you need inpatient hospital care, the hospice must arrange it. If it does not, you might owe the entire hospital bill.[1][3]

What the benefit will not cover once it starts:

• Treatment intended to cure the terminal illness and related conditions
• Prescription drugs meant to cure the illness rather than control symptoms
• Hospice care from a provider the hospice team did not set up
• Room and board if you receive hospice in your home or if you live in a nursing home or a hospice inpatient facility (except when the team arranges short-term inpatient or respite care)
• Hospital outpatient care, hospital inpatient care, or ambulance transportation unless the hospice team arranges it or the care is unrelated to the terminal illness and related conditions[1][3]

Call the hospice team before you go to an emergency room or hospital for the terminal illness.[1]

Four levels of hospice care

CMS pays hospices a daily rate for each day you are enrolled, based on one of four levels of care.[2]

1. Routine home care. This is the usual level when you are not in crisis and symptoms are being managed. CMS treats "home" as a private home, a skilled nursing facility, or an assisted living facility.[2]
2. Continuous home care. Brief periods of crisis, mainly nursing, in a home setting that is not an inpatient facility, as needed to keep you at home. Hospice aide or homemaker services can be part of that continuous day.[2]
3. Inpatient respite care. Up to 5 consecutive days in an approved inpatient facility (a hospice inpatient unit, hospital, or nursing home) so a family caregiver can rest. CMS notes that this level includes room and board for that stay.[2][3]
4. General inpatient care. A stay in an inpatient facility for pain control or acute or chronic symptom management that cannot be managed in other settings.[2]

You can receive respite more than once, but only on an occasional basis. Each stay is limited to 5 days, and the hospice arranges it.[3]

What families still pay

Medicare pays the hospice provider. There is no hospice deductible.[3] You still pay your monthly Part A and Part B premiums.[3]

For outpatient drugs used at home for pain and symptom management, you may owe a copayment of up to $5 per prescription.[1][4] CMS states the coinsurance as 5% of the drug's cost to the hospice, never more than $5.00, and that this copay applies during routine home care or continuous home care, not during general inpatient or respite days.[2] If the hospice benefit does not cover a particular drug, the hospice should contact your Medicare drug plan (if you have one) to see whether Part D covers it. The hospice must tell you if a drug or service is not covered, why, and whether you will have to pay.[1]

For inpatient respite, you may pay 5% of the Medicare-approved amount each day.[1] Medicare's booklet uses this example of the math: if Medicare approves $100 per day for inpatient respite, you pay $5 and Medicare pays $95.[3] Your respite copayments cannot be more than the inpatient hospital deductible for the year you first elected hospice.[1] In 2026 that Part A deductible is $1,736.[4]

Covered hospice services themselves are $0 when you use a Medicare-approved hospice.[1][4]

If you have a Medicare Supplement Insurance (Medigap) policy, Medicare's hospice booklet states that the policy will cover your hospice costs for drugs and respite care, and that it will also help with costs for health problems that are not part of the terminal illness.[3] For how Medigap works alongside Original Medicare, start with our Medicare Supplement page.

For health problems that are not part of the terminal illness and related conditions, Original Medicare still pays covered services. You owe the usual deductibles and coinsurance for that unrelated care.[1][3]

Room and board is the gap families often miss

Medicare does not cover room and board if you receive hospice at home, or if you live in a nursing home or a hospice inpatient facility.[1] If you already live in a facility and elect hospice, you may still have to pay that facility's room and board.[1]

The exception is short-term inpatient care or respite that the hospice team arranges. For those stays, Medicare covers the facility stay, with the small respite coinsurance described above.[1][3]

This is one practical reason hospice is not a stand-in for long-term care. Medicare does not pay for long-term custodial care, meaning help with dressing, bathing, and other daily tasks when that is the only care you need, whether at home or in a nursing home.[5] Hospice aides may help with bathing, dressing, and light homemaking as part of the hospice plan of care. That is not round-the-clock custodial staffing, and it does not pick up the monthly cost of a nursing-home bed.

How hospice differs from home health and long-term care

North Carolina families often hear "care at home" and assume one Medicare benefit covers every kind of help. Three benefits sit next to each other and do different jobs.

Hospice is a Part A election for a certified terminal illness. You agree to comfort care for that illness. The hospice is then responsible for related nursing, medications for comfort, equipment, aides, counseling, and short-term inpatient or respite care.

Medicare home health is skilled care in the home for an illness or injury, meant to help you get better, maintain function, or slow decline. You pay nothing for covered home health visits. Medicare does not pay for 24-hour care at home, home-delivered meals, or custodial personal care when that is the only service you need.[6] If you are sorting out skilled visits rather than end-of-life comfort care, our home health insurance page is the place to start.

Long-term care (also called custodial care) is help with everyday personal tasks over a long period. Medicare and most health insurance, including Medigap, do not pay for it.[5] For the separate question of long-term care insurance, see our long-term care page. This article stays with hospice.

If you have a Medicare Advantage Plan

Hospice care related to the terminal illness is paid by Original Medicare, even if you stay enrolled in a Medicare Advantage Plan.[1][3] You can remain in the plan as long as you keep paying the plan's premiums. The plan can still cover extra benefits that are medically necessary (Medicare names dental and vision as examples) and covered services for health problems that are not related to the terminal illness. You may get those unrelated services from Original Medicare or from the plan; cost-sharing depends on which you use. If you use Original Medicare and pay more than you would have paid under the plan, keep your receipts. The plan must reimburse the extra amount.[3]

If the plan includes drug coverage, it generally covers drugs that are not related to the terminal illness.[3] Related comfort medications should come through the hospice. Stay in contact with the hospice team, use a Medicare-approved hospice, and ask before you seek hospital care for the terminal illness.

Practical takeaways

• Confirm Part A, a 6-month prognosis certified by the hospice doctor and your regular doctor (if you have one), comfort-care goals, and a signed election with a Medicare-approved hospice.[1]
• Keep the hospice team in the loop before any hospital visit for the terminal illness. If the hospice did not arrange the stay, you might owe the full cost.[1][3]
• Budget $0 for covered hospice services, up to $5 per outpatient comfort-drug prescription, and 5% coinsurance for respite, capped at the 2026 Part A deductible of $1,736.[1][4]
• Plan separately for room and board if a loved one lives in a nursing home. Medicare hospice does not pay that rent except during hospice-arranged inpatient or respite stays.[1]
• Living past 6 months does not automatically end the benefit if a hospice doctor recertifies the prognosis.[3]
• You can stop hospice at any time and, if you still qualify, elect it again later.[3][7]
• Treat hospice, home health, and long-term custodial care as three different benefits. Do not expect one of them to do the work of the other two.[5][6]

How we can help

Have more questions or want to get in touch? Contact us or call (336) 937-7501.

Seniors Insurance Hub is an independent Medicare and senior insurance advisory serving Greensboro and the Piedmont. We sit with you, and with adult children helping a parent, to walk through how Original Medicare pays for hospice and how that differs from home health insurance and long-term care. We do not operate a hospice. We help families read the coverage rules in plain English.

Citations

1. Medicare.gov, "Hospice care" (2026-09-04)
2. Centers for Medicare & Medicaid Services, "Hospice" (2026-07-02)
3. Medicare.gov, "Medicare Hospice Benefits" (CMS Product No. 02154, 2026-03-06)
4. Medicare.gov, "Costs" (2026 Part A hospice cost-sharing and $1,736 inpatient deductible)
5. Medicare.gov, "Long-term care" (2026-09-03)
6. Medicare.gov, "Home health services" (2026-09-04)
7. Medicare.gov, "Medicare & Hospice Benefits: Getting Started" (CMS Product No. 11361, 2025-06)