Questions people ask
What is the 80/20 rule in hospice?
The 80/20 rule is a limit on the hospice provider, not on any patient. Under Medicare rules, a hospice's inpatient days may not exceed 20 percent of its total Medicare patient days in a year. The other 80 percent must be care where people live. The rule keeps hospice a home-based benefit. It does not limit the inpatient care one person can receive when it is medically necessary.
Reviewed by our medical director, October 12, 2026
On this page (5 sections)
Where the rule comes from
Medicare's hospice rules set out short-term inpatient care in 42 CFR 418.108 and the payment rules in 418.302. Across all of a hospice's Medicare patients, inpatient days, general inpatient care plus respite care, may not exceed 20 percent of the total days those patients spent on hospice in Medicare's cap year, the 12-month period Medicare uses to total hospice days.
The limit is applied to the hospice's Medicare payment, not to your bills. It exists because hospice was designed as care where people live. Most people receive routine home care on most days.
Which days count toward the 20 percent
| Level of care | Where | Counts toward the 20 percent? |
|---|---|---|
| Routine home care | Wherever the person lives, including a nursing facility or RCFE | No |
| Continuous home care | Wherever the person lives, only when medically necessary during a symptom crisis | No |
| General inpatient care | A hospital, hospice inpatient unit or contracted facility, only when medically necessary during a symptom crisis | Yes |
| Inpatient respite care | A contracted facility, up to 5 days at a time, to rest the caregiver | Yes |
The level of care is a clinical decision based on the person's needs on that day. A higher level is not a better kind of hospice. See levels of care.
What this means for your family
- No one is counting your days against a 20 percent limit. If the person needs general inpatient care for a symptom crisis, the hospice must assess and provide it when it is medically necessary.
- A person living in a nursing facility or RCFE (residential care facility for the elderly) is usually on routine home care there, because that is their home.
- Respite care is for the caregiver, up to 5 days at a time, on an occasional basis. Plan it with the social worker rather than waiting for a crisis.
- If you are told a higher level is not needed, ask the nurse what they assessed and what would change the answer.
Related questions
Does the rule mean a person can only spend 20 percent of their time in a facility?
No. The limit is across all of a hospice's Medicare patients in a year, not per person.
Is this the same as Medicare's 80/20 coinsurance?
No. Under Medicare Part B, Medicare pays 80 percent of the approved amount for many services and you pay 20 percent. Hospice is paid as a bundled daily rate with no 20 percent coinsurance for hospice care itself. The hospice 80/20 rule is about inpatient days.
Who decides the level of care?
The hospice team, led by the hospice doctor, using Medicare's definitions. You call when something changes, a nurse assesses, and the team and doctor decide. Nothing changes without the patient or their representative knowing.
Read more
The fuller pages: the four levels of hospice care and paying for care.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- October 12, 2026
- Next review
- April 12, 2027
How we write and review this site
Sources
- 42 CFR 418.108: Short-term inpatient care (opens in a new tab)
- 42 CFR 418.302: Payment procedures for hospice care, including the inpatient day limit (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (844) 646-4434 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice