What happens if you live longer than 6 months on hospice?

If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you're terminally ill. You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.

medicare.gov - How hospice works - Medicare

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Medicare only covers your

hospice care

if the hospice provider is Medicare-approved. To find out if a hospice provider is Medicare-approved, ask one of these:

Your doctor

The hospice provider

Your state hospice organization

Your state health department

If you're in a Medicare Advantage Plan (like an HMO or PPO) and want to start hospice care, ask your plan to help find a hospice provider in your area. Your plan must help you locate a Medicare-approved hospice provider in your area. If you qualify for hospice care, you and your family will work with your hospice team to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your national or state hospice organization.

Find hospice care.

Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan. If you were in a Medicare Advantage Plan before starting hospice care, you can stay in that plan, as long as you pay your plan’s premiums. When you get hospice care, your Medicare Advantage Plan can still cover services that aren't a part of your terminal illness or any conditions related to your terminal illness.

Care for your other conditions

Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness. Your hospice benefit will cover these services even if you remain in a Medicare Advantage Plan or other Medicare health plan. After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren’t part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren’t part of your terminal illness and related conditions. You can get covered services for any health problems that aren’t part of your terminal illness and related conditions. You can choose to get services not related to your terminal illness from either your plan or Original Medicare. What you pay will depend on the plan and whether you follow the plan’s rules like seeing in-network providers. If your plan covers extra services that aren’t covered by Original Medicare (like dental and vision benefits), your plan will continue to cover these extra services as long as you continue to pay your plan’s premiums and other costs. Note If you start hospice care on or after October 1, 2020, you can ask your hospice provider for a list of items, services, and drugs that they’ve determined aren’t related to your terminal illness and related conditions. This list must include why they made that determination. Your hospice provider is also required to give this list to your non-hospice providers or Medicare if requested.

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Where you get hospice care

The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If your hospice team determines that you need inpatient care, they'll make the arrangements for your stay. If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care.

How long you can get hospice care

Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill. You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You have the right to change your hospice provider once during each benefit period. At the start of the first 90-day benefit period, your hospice doctor and your regular doctor (if you have one) must certify that you’re terminally ill (with a life expectancy of 6 months or less). At the start of each benefit period after the first 90-day period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill, so you can continue to get hospice care. Note: Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have 6 months or less to live.

Stopping hospice care

If your health improves or your illness goes into remission, you may no longer need hospice care. You always have the right to stop hospice care at any time. If you choose to stop hospice care, you'll be asked to sign a form that includes the date your care will end. You shouldn’t be asked to sign any forms about stopping your hospice care at the time you start hospice. Stopping hospice care is a choice only you can make, and you shouldn't sign or date any forms until the actual date that you want your hospice care to stop.

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If you were in a Medicare Advantage Plan when you started hospice, you can stay in that plan by continuing to pay your plan’s premiums. If you stop your hospice care, you’re still a member of your plan and can get Medicare coverage from your plan after you stop hospice care. If you weren’t in a Medicare Advantage Plan when you started hospice care, and you decide to stop hospice care, you can continue in Original Medicare. If you’re eligible, you can go back to hospice care at any time. You and your family members are the most important part of a team that may also include:

Doctors

Nurses or nurse practitioners

Counselors

Social workers

Pharmacists

Physical and occupational therapists

Speech-language pathologists

Hospice aides

Homemakers

Volunteers

A hospice doctor is part of your medical team. You can also choose to include your regular doctor or a nurse practitioner on your medical team as the attending medical professional who supervises your care. In addition, a hospice nurse and doctor are on-call 24 hours a day, 7 days a week, to give you and your family support and care when you need it.