8 min read ยท Last updated August 26, 2026
- Electing hospice waives Medicare payment for curative treatment of the terminal illness and related conditions, not care for anything else, under the federal hospice regulation (Title 42 of the Code of Federal Regulations, section 418.24(g)).
- The benefit runs in periods, not indefinitely: two initial 90-day periods, then unlimited 60-day periods, each requiring recertification of a six-month-or-less prognosis.
- The election can be revoked in writing at any time, and regular Medicare coverage for the waived treatment resumes immediately.
- Out-of-pocket costs are capped: up to $5 per prescription for pain and symptom drugs, and up to 5% coinsurance for inpatient respite care.
In this article
- What the hospice election actually changes
- What stays covered outside the terminal diagnosis
- How long the election lasts
- The revocation right: reversing the decision
- Mistakes families make in the first 72 hours
- Frequently asked questions
Renee’s father is 82, and his oncology team told the family this week that treatment for his stage IV lung cancer has stopped working. The word they used was hospice. Nobody in the room understood exactly what agreeing to that word would change, and what it would leave alone.
Electing the Medicare hospice benefit is not a vague step toward comfort care. It is a specific legal election, defined in the federal hospice regulation at Title 42 of the Code of Federal Regulations (CFR), part 418. That election trades one clearly defined set of treatments for another. Knowing exactly what gets traded, and what does not, is the difference between signing something the family misunderstands and making an informed choice before anyone signs anything.
What the hospice election actually changes
A hospice doctor and the patient’s regular doctor must certify a life expectancy of six months or less. Once the patient or family signs the hospice election statement, one specific trade happens under 42 CFR 418.24(g), the federal regulation that governs the hospice benefit. Medicare stops paying for treatment aimed at curing the terminal illness, or any condition related to it, for as long as the hospice election stays active.
In plain terms: curative treatment means care meant to fix or reverse the disease itself, like chemotherapy aimed at shrinking a tumor, surgery to remove it, or a hospital admission to treat it directly. The hospice team takes over that condition instead, with comfort-focused care: pain control, symptom management, nursing visits, counseling, and equipment delivered to wherever your parent lives.
The election statement itself has to say more than yes. Under the same regulation, the statement must name the hospice and the attending physician the family has chosen. It must also include a signed acknowledgment that the patient understands hospice means palliative care, not curative care, for that specific diagnosis. Ask to see this document before anyone signs it. It should already spell out which parts of your parent’s care hospice will and will not pay for.
What stays covered outside the terminal diagnosis
The waiver in 418.24(g) is scoped narrowly, on purpose. It only reaches care related to the terminal illness. If your parent breaks a wrist or develops an unrelated infection, Medicare pays for that care exactly as it did before hospice started. The same is true for a routine visit tied to any condition unrelated to the terminal diagnosis. Your parent’s normal deductibles and coinsurance still apply.
There is a second exception families miss. Your parent’s own longtime doctor, called the attending physician, can keep getting paid by Medicare for services related to the terminal illness too. That only holds as long as the doctor is not a hospice employee and is not being paid by the hospice for those services. Electing hospice does not force your parent to give up the doctor who has known them for years.
If this conversation started during a hospital stay, the discharge planning that happened then, including what Medicare’s home health benefit covers, follows different rules than hospice does now. Ask the hospice team directly which of your parent’s current medications and providers move with them into hospice, and which do not.
| Type of care | What happens once hospice is elected |
|---|---|
| Comfort and symptom care for the terminal illness | Covered in full by the hospice team |
| Curative treatment for the terminal illness (chemotherapy, surgery to cure it, hospital admission to treat it) | Waived. Medicare will not pay for it while the election is active |
| Prescription drugs for pain and symptom control | Covered, up to a $5 copay per prescription |
| Prescription drugs meant to cure the terminal illness | Waived |
| Care for health problems unrelated to the terminal illness | Still covered under regular Medicare, standard deductible and coinsurance apply |
| Short-term inpatient or respite care arranged by the hospice team | Covered, up to 5% coinsurance, capped at the Part A inpatient deductible |
| Attending physician services, if not hospice-employed | Still covered |
| Emergency room visit, hospital stay, or ambulance not arranged by the hospice team | Waived unless the hospice team confirms it is unrelated to the terminal illness |
How long the election lasts
The hospice benefit is not one open-ended commitment. Under 42 CFR 418.21, it runs in defined periods: an initial 90-day period, a second 90-day period, and then an unlimited number of 60-day periods after that. Each period has to be renewed.
For the first six months, that renewal is simple: the hospice medical director recertifies that your parent still meets the six-month prognosis. After six months, the standard tightens. Under 42 CFR 418.22, the hospice medical director or hospice doctor has to meet with your parent face to face before recertifying for the third benefit period, and do that again before every 60-day period after that.
Nothing about the 90-day and 60-day structure requires your family to decide anything today beyond the current period. If your parent’s condition changes, improves, or the family’s judgment about hospice changes, the next recertification point is a real decision point, not a formality.
The revocation right: reversing the decision
Under 42 CFR 418.28, your parent, or whoever is legally acting for them, can revoke the hospice election at any time during an active election period. There is no need to wait for a recertification date, and no doctor’s sign-off required.
Revoking takes one signed statement filed with the hospice: a statement saying the election is revoked for the rest of that period, plus the date the revocation takes effect. That date cannot be earlier than the day the statement is signed.
Once revoked, your parent is no longer covered under the hospice benefit, but everything that was waived under 418.24(g), including curative treatment for the terminal illness, comes back under regular Medicare right away. The hospice has five calendar days to notify Medicare’s contractor. Your parent can also elect hospice again later, for any future period they still qualify for. Revoking once does not use up the benefit.
Mistakes families make in the first 72 hours
Two mistakes show up again and again in this exact conversation. The first is assuming hospice means giving up all medical care. It does not. It means giving up curative treatment for one specific diagnosis, while everything else keeps working the way it did before.
The second is not knowing the revocation right exists at all. Families sometimes stay in a hospice election they are unhappy with because nobody told them they could leave it. You can leave it, in writing, on any day.
Before anyone signs the election statement, ask the hospice team for the written list. It is called an election statement addendum, and it names exactly which conditions, items, and drugs the hospice has determined are unrelated to the terminal illness and will not be covered. Get that answer before the signature, not after the first bill.
Frequently asked questions
Does electing hospice mean my parent can’t go to the hospital anymore? No. Your parent can still go to the hospital for anything unrelated to the terminal illness, and Medicare pays as usual. For the terminal illness itself, hospital care only stays covered if the hospice team arranges it or confirms it is unrelated. Call the hospice team before an emergency room visit whenever possible.
Can we change our minds after signing the hospice election? Yes. Your parent or their representative can revoke the election in writing at any time, under the federal hospice regulation at 42 CFR 418.28. Regular Medicare coverage for the waived treatment resumes right away, and your parent can elect hospice again later for any future period they still qualify for.
Will my parent’s regular doctor still be involved? Often, yes. If your parent’s longtime doctor is named as the attending physician and is not a hospice employee, Medicare still pays that doctor for services related to the terminal illness. Ask the hospice team to confirm your parent’s doctor is listed this way in the election statement.
How much does hospice cost under Medicare? For a Medicare-approved hospice, most care costs nothing. You may pay up to $5 per prescription for pain and symptom drugs, and up to 5% coinsurance for inpatient respite care, capped at the Part A hospital deductible. Care unrelated to the terminal illness keeps its normal Medicare cost-sharing.
How long does the hospice benefit last? It runs in periods, not indefinitely: an initial 90 days, a second 90 days, then unlimited 60-day periods after that. Each period requires recertification that your parent still has a life expectancy of six months or less, with a required in-person visit after the first six months.
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