Many patients under hospice care live longer than six months; some are under hospice care for a year or more. If, at the end of the first six-period on hospice, the patient hasn’t improved or their health has declined, he or she can continue to get hospice care if the hospice medical director or hospice doctor recertifies the patient is terminally ill with a life expectancy of six months or less based on the usual course of their disease.

An individual is eligible for hospice care for two, 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of each benefit period, the hospice medical director or hospice doctor must recertify the patient is terminally ill. A patient may change providers only once during each benefit period.

If the Patient’s Condition Improves and They No Longer Need Hospice, What Happens?

Sometimes a person’s health improves or their illness goes into remission and the hospice physician determines that the patient no longer needs hospice care. If this happens, the patient is discharged from hospice and returns to the care and coverage (Medicare or other medical insurance) they had before electing the hospice benefit.

A patient retains the right to stop receiving hospice care at any time and for any reason. If a patient elects to terminate hospice care, they revert to the type of Medicare coverage they had before electing hospice, be it Original Medicare, a Medicare Advantage Plan (like an HMO or PPO), or another type of Medicare health plan. If a patient chooses to leave hospice care, his or her Medicare Advantage Plan will not start again until the first of the following month.

To terminate hospice care, the patient signs a form indicating the date care will end. An individual may return to hospice care at any time in the future if eligibility requirements are met.

Must the Patient Sign a “Do Not Resuscitate” (DNR) Form to Qualify for Hospice Care?

A “Do Not Resuscitate” (DNR) order means that if a patient’s heart or breathing stops, no cardiopulmonary resuscitation is attempted nor cardiac life support implemented to try to revive the patient or keep them alive. Patients do not need to have a DNR order signed at the time of their enrollment into hospice. However, since, by definition, a person on hospice has accepted the prospect of their death and dispensed with curative or heroic treatment efforts, attempts to resuscitate the patient are contrary to this philosophy. Often, physicians rely on hospice to get a DNR order signed by the patient because they’re reluctant to talk to their patient about this. Hospice staff therefore encourage the patient and family to sign the DNR order as soon after enrollment as possible. In practice, many hospices choose to give patients and families time to adjust to the diagnosis and prognosis of the terminal illness before presenting the DNR order for consideration. 

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