Hospice Eligibility Requirements: Medicare Criteria and Documentation
A practical, source-linked overview of who may elect the Medicare hospice benefit and what hospice teams need to document at admission and recertification.
Short answer: A person may elect the Medicare hospice benefit if they have Medicare Part A, are certified by an authorized physician as terminally ill with a life expectancy of six months or less if the illness runs its normal course, and choose hospice care from a Medicare-approved hospice. The hospice record must support the physician's patient-specific judgment and meet certification, election, and recertification requirements.[1]
What are the Medicare hospice eligibility requirements?
Medicare.gov describes three core conditions. The person must be entitled to Part A, have a terminal-illness certification from the hospice doctor and their regular doctor if they have one, and elect comfort-focused hospice care instead of treatment to cure the terminal illness and related conditions. The person must receive care through a Medicare-approved hospice.[1]
The six-month prognosis is a clinical certification standard, not a fixed limit on how long someone may receive hospice. Coverage can continue through later benefit periods when the hospice physician recertifies that the person remains eligible.[1]
What should the hospice record support at admission?
For the first 90-day period, CMS requires oral or written certification no later than two calendar days after hospice care begins. If written certification is not obtained within that window, oral certification is required within the same period, and the hospice must obtain written certification before submitting a claim. Certification is completed by the hospice medical director or a physician member of the interdisciplinary group, and by the attending physician when the patient has one.[2][3]
The clinical narrative should explain the findings that support the physician's prognosis for this individual. CMS says the narrative must reflect the patient's individual clinical circumstances, rather than relying on checkboxes or standard language used for every patient.[2]
CMS also limits how early certification may be completed: no more than 15 calendar days before the effective date of the election or next benefit period. The record should identify the applicable benefit-period dates and contain the required signatures and dates.[2][3]
When is a face-to-face encounter required for recertification?
A hospice physician or nurse practitioner must have a face-to-face encounter with the patient before the start of the third benefit period and before each later benefit period. The encounter must generally occur no more than 30 calendar days before the recertification. The certifying or recertifying terminal illness must still be signed by a physician; an NP may conduct the face-to-face encounter but cannot certify or recertify the terminal illness.[2][3]
For the third and later benefit periods, the physician's recertification narrative must explain how the clinical findings from the face-to-face encounter support a life expectancy of six months or less.[2]
How long can Medicare hospice coverage continue?
The benefit is structured as two 90-day periods followed by an unlimited number of 60-day periods. A person may continue receiving hospice care after the first six months when they continue to meet eligibility requirements and the hospice physician completes the required recertifications.[1]
What this means for hospice operations
Clinical eligibility is a physician judgment. Operationally, teams need the relevant record, individualized clinical narrative, signatures, dates, and recertification evidence available for review at the right point in the benefit period.
How Aether supports the review workflow
Aether organizes referral records into a structured case and source-linked evidence for physician review. It supports the hospice team's documentation workflow; the hospice's clinicians and physician retain clinical judgment and certification responsibility.
This guide summarizes federal Medicare sources for general education. Apply current CMS manuals, applicable regulations, Medicare Administrative Contractor guidance, and patient-specific clinical judgment to each case.