Can you stay on hospice longer than six months?
The short answer
Yes. The six-month rule is about who qualifies, not a deadline. If your loved one lives longer than six months, Medicare keeps covering hospice as long as a hospice doctor recertifies that they are still terminally ill. If their health improves, they may be discharged, and they can come back later if they qualify again.
This topic involves medical decisions. It's general information, not advice for your person. Please talk with your hospice nurse or doctor before changing any medicine or care plan.
What does the six-month rule mean?
To start hospice, your loved one's doctor and the hospice doctor certify that they are expected to live six months or less if the illness runs its normal course. That is a medical estimate, and doctors can't predict exactly how long someone will live. Living past six months does not end hospice. Some people stay on hospice much longer, for example with a slow illness like dementia.
How does the time work?
Medicare gives hospice in benefit periods:
- Two 90-day periods
- Then an unlimited number of 60-day periods
At the start of each new period after the first, a hospice doctor must recertify that your person is still terminally ill. Your person doesn't need to sign up again for each period.
What is the face-to-face visit?
Before the third benefit period, and before every period after that, a hospice doctor or hospice nurse practitioner must see your person in a face-to-face visit. That visit helps the doctor decide whether your person still qualifies. In practice, this first comes up about six months into hospice.
If a visit is coming up, it's fine to ask the hospice when it will happen and who will come.
What if your person gets better?
Sometimes health steadies or improves, and the hospice doctor can no longer recertify. Your person is then discharged from hospice. Families sometimes call this "graduating."
When this happens:
- Regular Medicare coverage starts again
- Your person can return to hospice later if they qualify, with no waiting period
A hospice can't discharge someone just because their care is costly. The hospice should also plan the discharge with your family ahead of time, not all at once.
What if you disagree with a discharge?
You have the right to ask for a fast appeal. The hospice should give you a written notice explaining this right, two days or more before services end. If you don't get one, ask for it.
The notice names an independent reviewer, called a BFCC-QIO, and explains how to appeal. Follow the instructions on the notice. The deadline is noon the day before the date listed for services to end.
If you need help, your State Health Insurance Assistance Program (SHIP) can help you understand an appeal. You can also call 1-800-MEDICARE.
Sources
- Medicare.gov, Hospice care: medicare.gov/coverage/hospice-care
- CMS, Medicare Hospice Benefits (booklet 02154): medicare.gov/publications/02154-medicare-hospice-benefits.pdf
- CMS, Medicare Benefit Policy Manual, Chapter 9: cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c09.pdf
- Medicare.gov, Your right to a fast appeal: medicare.gov/claims-appeals/your-right-to-a-fast-appeal
Educational information only. This article is not medical, legal, or financial advice, and it can't account for your person's health or your state's rules. Always talk with your hospice team, doctor, or Medicare (1-800-MEDICARE) about your situation. If you think it's an emergency, call your hospice's 24-hour number or 911.