Under Medicare, choosing hospice is a formal election: you (or your representative) sign that you want the hospice benefit for a terminal illness and generally agree to palliative rather than curative treatment for that illness. Coverage runs in benefit periods—the first two are commonly 90 days each, then unlimited 60-day periods—as long as a physician recertifies that the prognosis still meets hospice criteria. This clock is not the Part A hospital/SNF benefit period 60-day reset, and it is not the home health 30-day PDGM period. Hospital deductible framing: Medicare Part A benefit period basics. Bill habits: Medical bills and insurance.
Election periods at a glance
| Clock | Typical length | What keeps it going | Watch-out |
|---|---|---|---|
| First hospice benefit period | 90 days | Initial certification of terminal illness (generally ≤6-month prognosis if illness runs its normal course) | Election statement and hospice choice must be on file |
| Second hospice benefit period | 90 days | Recertification before the period ends | Missed recertification can interrupt coverage |
| Later periods | 60 days each | Recertification each period; face-to-face encounter rules can apply for later periods | Unlimited periods if criteria still met |
| Revoke / discharge / transfer | Ends or moves the election | You can revoke to seek curative care; you may re-elect later | Room-and-board in a nursing facility is often still patient-pay even when hospice covers the hospice benefit |
CMS and Medicare.gov publish current hospice coinsurance rules (for example, limited inpatient respite coinsurance and outpatient drug coinsurance in some designs). Use the official figures for your year—not a blog table.
How Medigap and Advantage change the bill
Standardized Medigap letters can help with some Part A/B cost-sharing, but hospice has its own limited patient-pay items; read the letter outline and Medicare hospice fact sheets together. Medigap premiums (UnitedHealthcare, Humana, Mutual of Omaha, regional Blues, etc.) are separate from hospice provider bills.
Medicare Advantage enrollees who elect hospice typically receive hospice through Original Medicare for the hospice benefit while other plan services may still interact with the Advantage plan—confirm with the plan’s Evidence of Coverage and the hospice intake team (Medicare Advantage MOOP basics).
Worked example: two 90-day periods, then a 60-day recert
Jordan elects hospice on March 1 with a Medicare-certified hospice (illustrative VITAS-, Kindred-, or regional nonprofit-style provider). Period 1 runs roughly March 1–May 29 (90 days). Before it ends, the hospice physician recertifies; Period 2 runs the next 90 days. Near the end of Period 2 the team schedules the required recertification (and any face-to-face rules that apply for later periods). Period 3 is a 60-day clock. Jordan’s family tracks calendar end dates with the hospice social worker so a missed signature does not create a surprise patient-pay gap.
If Jordan revokes election on day 40 of Period 1 to try a curative hospital admission, hospice coverage for that election stops; Jordan may re-elect later if eligible. That revoke decision is separate from whether a hospital stay starts a new Part A benefit period for deductible math.
Practical habits
- Ask the hospice: “Which election period am I in, and when is recertification due?”
- Keep a copy of the signed election statement and any revoke/transfer forms.
- Separate hospice benefit bills from nursing-facility room-and-board statements.
- If on Advantage, confirm what still routes through the plan vs Original Medicare hospice.
- Call your state SHIP program before paying a collection demand you do not understand.
- Do not mix hospice 90/60 clocks with SNF 100-day or home health 30-day math.
Checklist
- Confirm Original Medicare hospice election vs any Advantage plan interactions.
- Note whether you are in a first/second 90-day period or a later 60-day period.
- Calendar the recertification deadline with the hospice, not only the hospital discharge planner.
- Budget for limited coinsurance items and non-covered room-and-board when applicable.
- Document revoke or transfer decisions in writing.
- Re-check MSNs until period dates and hospice provider NPIs match your calendar.
Related skilled-care clocks: SNF benefit period basics and Home health episode of care basics.
Inpatient respite days that give home caregivers a break under the hospice benefit: Medicare respite care basics.
Educational only. Not insurance, tax, legal, or medical advice. Not a plan or hospice recommendation. Hospice election rules, recertification and face-to-face requirements, coinsurance amounts, Medigap letter benefits, and Advantage designs change; confirm with Medicare.gov, your state SHIP program, the hospice, and insurer outlines of coverage.