Hospice Eligibility Requirements: Medicare Rules & Clinical Criteria
Learn how hospice eligibility requirements work—including Medicare requirements for hospice—and how to confirm
hospice care eligibility requirements for your loved one.
Families often ask, “Do we meet the hospice eligibility requirements?” This guide explains the core
hospice requirements—from physician certification and prognosis to the official
Medicare requirements for hospice—so you can decide with confidence. If you’re unsure whether your loved one’s condition meets
hospice care eligibility requirements, use the checklists below and discuss them with your doctor.
Core Hospice Requirements (At a Glance)
- Terminal prognosis of six months or less if the disease follows its usual course.
- Physician certification by the attending doctor and hospice medical director.
- Election of comfort-focused care rather than curative treatment.
Meeting these hospice care eligibility requirements allows patients to receive symptom management, caregiver support, and
spiritual counseling tailored to their goals of care.
Medicare Requirements for Hospice
- The patient is eligible for Medicare Part A.
- Two physicians certify a terminal illness with a six-month prognosis.
- The patient (or representative) elects the hospice benefit instead of curative care.
- Care is delivered by a Medicare-approved hospice provider.
For official details, review Medicare’s coverage page:
Medicare — Hospice Care Coverage.
Understanding these Medicare requirements for hospice helps families plan for coverage of nursing visits, medications related to
the terminal diagnosis, medical equipment, and bereavement services.
Conditions That Often Meet Hospice Care Requirements
A variety of advanced illnesses may meet hospice eligibility requirements when functional decline and clinical markers are present:
- Advanced cancer with declining performance status
- End-stage heart disease (e.g., CHF) with frequent symptoms at rest
- End-stage lung disease (e.g., COPD) with oxygen dependence and reduced activity
- Progressive neurological disorders (e.g., Parkinson’s) with significant functional loss
- End-stage dementia/Alzheimer’s with limited verbal ability and dependence in ADLs
- Advanced liver or renal failure with persistent complications
If these patterns sound familiar, your loved one may meet hospice requirements. Speak with your clinician to confirm.
Why Meeting Hospice Requirements Early Matters
Earlier confirmation of hospice care eligibility requirements provides more time for pain control, emotional support,
equipment delivery, and caregiver relief. It can also clarify financial planning, including who covers services and how long hospice may last:
Real Stories: Families Navigating Hospice
“We thought it was too early, but Sahara Hospice reviewed the hospice eligibility requirements with our doctor. Once enrolled, Dad’s
breathlessness and anxiety were finally controlled.”
“Mom had late-stage dementia. Sahara explained the Medicare requirements for hospice and coordinated equipment and medications the same
week. We felt supported and informed.”
Check Hospice Care Eligibility with Sahara Hospice Care
Still unsure about your loved one’s hospice eligibility requirements? Our team can coordinate with physicians, confirm the
Medicare requirements for hospice, and design a comfort-focused plan that honors your goals.
Call: 281-245-9977
Frequently Asked Questions
Who decides if my loved one meets hospice eligibility requirements?
The attending physician and a hospice medical director certify eligibility based on clinical criteria, prognosis, and goals of care.
If we choose hospice, can we return to curative treatment later?
Yes. Patients can revoke hospice at any time. If their condition improves or goals change, curative treatment can resume.
Do Medicare requirements for hospice cover medications and equipment?
When eligibility is met, Medicare typically covers medications related to the terminal diagnosis, durable medical equipment, and hospice team visits.
How do we know if symptoms meet hospice care eligibility requirements?
Look for sustained decline—weight loss, increased falls, frequent hospitalizations, oxygen needs, and dependence with daily activities—then consult your doctor.