Caregiver Support14 mins
Hospice guide
Hospice and palliative care, explained.
Hospice brings comfort-focused care to people near the end of life, wherever they live, and Medicare covers nearly all of it. Here is how it differs from palliative care, what the benefit covers, the levels of care and how to choose a hospice.
- Medicare-certified hospices in CMS’s files, across 50 states, D.C. and 4 territories
- 7,076
- of Medicare beneficiaries who died in 2024 used hospice
- 52.9%
- days: the median length of a hospice stay
- 19
- the most you pay per prescription for symptom relief
- $5
MedPAC, March 2026 report (2024 data); CMS hospice file, loaded September 2026.
01The difference
Hospice vs. palliative care
Both put comfort first. The difference is timing: palliative care can start at any stage of a serious illness, while hospice is for the last months of life, when a cure is no longer the aim.
| Hospice | Palliative care | |
|---|---|---|
| Goal | Comfort and quality of life when a cure is no longer the aim | Relief from symptoms and stress at any stage of a serious illness |
| Who qualifies | A doctor expects six months or less to live if the illness runs its usual course | Anyone with a serious illness; no prognosis is required |
| Treatment | You stop treatment meant to cure the terminal illness; care for other conditions continues | Can come alongside treatment meant to cure or slow the illness |
| Who pays | Medicare Part A covers nearly everything related to the terminal illness | Usually billed like other medical care under Medicare Part B or other insurance |
| Where | Mostly at home or in a nursing home; also inpatient units and hospitals | Hospitals, clinics and some home programs |
Does hospice shorten life?
The evidence says no. In a large Medicare study, hospice patients lived as long as similar patients who didn't use hospice, and for some conditions, including heart failure and lung and pancreatic cancer, they lived longer.7
A separate randomized trial found that adding palliative care early in treatment for advanced lung cancer improved quality of life and mood, and patients lived longer.8
02Medicare benefit
What the Medicare hospice benefit covers
Medicare Part A covers hospice when a doctor certifies that someone is expected to live six months or less if the illness runs its usual course, and the person chooses comfort care instead of curative treatment.
What's covered
- Nurse and doctor visits, and hospice aide and homemaker services
- Drugs for pain and symptom relief
- Medical equipment and supplies, such as a hospital bed or oxygen
- Physical, occupational and speech therapy, and dietary counseling
- Social work, counseling and spiritual care
- Short-term inpatient care when symptoms can’t be managed at home
- Inpatient respite care so family caregivers can rest, up to 5 days at a time
- Grief support for the family for up to a year after the death
- What you pay
Little, with one big exception
Up to $5 per prescription for pain and symptom drugs, and 5% of the Medicare-approved amount for inpatient respite care. Medicare doesn't pay room and board at home, in a nursing home or in a hospice facility.1
- Your choices
You stay in control
You can change hospice providers once in each benefit period, stop hospice at any time and go back to regular Medicare coverage, and elect hospice again later if you qualify.1
How long coverage lasts
Two 90-day benefit periods, then an unlimited number of 60-day periods, as long as the person remains eligible. At the start of each period a hospice doctor recertifies the prognosis, and before the third period a hospice doctor or nurse practitioner must see the patient face to face.2
03Levels of care
The four levels of hospice care
Hospice is a service, not a place. Medicare defines four levels of care, and most hospice days are routine care wherever the patient lives.
- Most days
Routine home care
Regular visits from the hospice team wherever you live: a private home, an assisted living community or a nursing home.
- During a crisis
Continuous home care
Mostly nursing care at home for longer stretches during a short period of crisis, to keep someone at home.
- Symptoms out of control
General inpatient care
Short-term care in a hospice inpatient unit, hospital or nursing home when pain or other symptoms can’t be managed at home.
- A break for caregivers
Inpatient respite care
A short inpatient stay, up to 5 days at a time, so family caregivers can rest.
Levels of care: 42 CFR 418.302.5 Respite limit: Medicare.gov.1
04Choosing a hospice
How to choose a hospice
Quality varies, and the choice matters most when time is short. Look at CMS's family survey results, understand who runs the hospice, and ask direct questions.
Ownership
For-profit hospices now make up about 82% of Medicare hospices and serve about 60% of patients; they account for all of the growth in recent years.6
Research finds differences on average. For-profit hospices tend to have longer stays (120 days on average in 2024, against 71 at non-profits) and more patients discharged alive, reflecting more patients with dementia or living in nursing homes.6,9 Individual hospices vary, so ask the questions below.
1,916 of the hospices in CMS's files (27%) were certified in the past five years. A newer hospice may be excellent, but it has less of a track record to check.
Questions to ask
How fast will a nurse come in a crisis?
Hospices must make nursing, doctor services and drugs available 24 hours a day, 7 days a week. Ask how quickly a nurse arrives in person at 2 a.m., not just how soon someone calls back.
How often will the team visit?
Ask how often nurses, aides, social workers and chaplains visit, and how big each nurse’s caseload is.
Where do patients go if symptoms get out of control?
Ask whether the hospice has its own inpatient unit or contracts with a hospital or nursing home, and how quickly it can arrange general inpatient care.
How do you support family caregivers?
Ask about training before a loved one comes home, aide and volunteer visits, respite care and grief support after a death.
What does CMS’s family survey say?
On Medicare’s Care Compare, look up the family caregiver survey rating and the Hospice Care Index for any hospice you are considering.
24-hour availability: 42 CFR 418.100.4 CMS hospice quality data: CMS.10
05FAQ
Questions families ask
What is the difference between hospice and palliative care?
Both focus on comfort. Palliative care can start at any stage of a serious illness and continue alongside treatment meant to cure it. Hospice is for people expected to live six months or less who have decided to stop curative treatment for the terminal illness, and Medicare’s hospice benefit covers it.
Does choosing hospice mean giving up?
No. It changes the goal of care to comfort and quality of life. In a large Medicare study, hospice patients lived as long as, and for some conditions longer than, similar patients who did not use hospice.
Can you leave hospice?
Yes. You can stop hospice care at any time and return to regular Medicare coverage for your illness, and you can elect hospice again later if you still qualify. You can also change hospice providers once in each benefit period.
Does Medicare pay for room and board?
No. Medicare does not pay room and board at home, in a nursing home or in a hospice inpatient facility, except during short-term inpatient or respite stays arranged by the hospice. Medicaid may help for people who qualify.
How long can someone stay on hospice?
As long as they remain eligible. After two 90-day benefit periods come unlimited 60-day periods, and a hospice doctor must recertify at the start of each one, with a face-to-face visit before the third.
Does CMS star-rate hospices?
There is no overall hospice star rating. CMS publishes a family caregiver survey rating, based on surveys of families after a death, for hospices with enough responses, plus the Hospice Care Index. Find them on Medicare’s Care Compare; our hospice search shows ownership and certification details.
06Sources
Where this guide comes from
Every rule and figure on this page, with a link to the original.
Written by the Care Ratings Team and reviewed by the TCR Editorial Team. Last reviewed . How our data works: methodology.
This guide is general information, not medical, legal or financial advice. Coverage rules change; check Medicare.gov or call 1‑800‑MEDICARE (1‑800‑633‑4227) about your own situation.
Next step
Find hospice providers near you.
See ownership, certification and member reviews for Medicare-certified hospices that serve your area.
