Medicare's hospice eligibility rules are straightforward. Here's exactly what you need to qualify.
The three core eligibility requirements
Medicare hospice eligibility rests on three requirements. First, you must be enrolled in Medicare Part A (hospital insurance). Second, your hospice physician and your regular attending doctor must certify that you are terminally ill, meaning a life expectancy of about 6 months or less if the illness follows its normal course. Third, you must sign a statement electing the hospice benefit, choosing comfort-focused care instead of treatment aimed at curing your terminal illness. You keep regular Medicare coverage for any health problems unrelated to your terminal condition. Meeting all three opens the full hospice benefit at virtually no cost.
Recertification and staying eligible
The 6-month prognosis is an estimate, not a deadline. Hospice care is divided into benefit periods: two 90-day periods, then an unlimited number of 60-day periods. At the start of each period, the hospice medical director must recertify that you still meet the terminal-illness criteria. If you live longer than expected, you keep your hospice benefit as long as you're recertified. If your condition improves, you can be discharged and re-enroll later if you decline again. You can also voluntarily revoke hospice and return to curative care at any time. Questions about your coverage? Call 1-800-MEDIGAP.