Hospice Eligibility Criteria

Hospice is available to patients with a terminal diagnosis and life expectancy of six months or less, as determined by the patient's doctor and a hospice medical director. The patient or the family must be aware of the prognosis and decide on comfort care rather than curative treatment for the terminal condition.

Determining a prognosis of six months or less can be challenging. Awareness of decline requires understanding a patient's condition over time. That's why primary care doctors are essential for determining eligibility.

The second criteria for hospice eligibility is an assessment by a hospice medical director or a nurse with specialized hospice training.

Hospice pre-election consultations

Medicare allows and reimburses for a one-time visit by a physician who is either the medical director of or employee of a hospice agency. Consultations are free to patients and family and without obligation.

  • Evaluate the need for pain and symptom management
  • Counsel the individual regarding hospice and other care options
  • Advise the individual regarding advanced care planning
  • Hospice Pre-Election Evaluation and Counseling information - CMS-R386CP.pdf

Staff at Compassus hospice locations are available for no-obligation consultations.

The Medicare.com hospice website includes information about covered services, plans and criteria.

Eligibility in context with the hospice decison

For many patients and families, hospice offers peace and a chance to focus on what's important. If a patient is eligible for hospice, we know the decision to choose hospice is difficult.

Open communication is key. That’s why we encourage patients and families to start conversations with each other and with the patient's doctor. Advance care planning can bring clarity to a patient's end-of-life goals and help doctors and families understand the wishes of the patient.

It is important for patients and families to know that anyone can make a referral to hospice. Studies show that patients who receive care early benefit substantially more than those who enter hospice during the final days or hours of life.

Hospice-appropriate individuals may experience some or all of the following:

  • Frequent hospitalizations
  • Progressive weight loss
  • Deteriorating mental abilities
  • Recurrent infections
  • Specific decline in condition
hospice for mother

Hospice is a fully covered Medicare benefit

Coverage includes nurses, other caregivers, medicines, supplies, equipment and support, with no out-of-pocket expenses for the hospice diagnosis.