Can you leave hospice?

How do you leave hospice?

You or your representative sign a statement that you are revoking the hospice election, with the date it takes effect. The hospice gives you the form and files it. The date cannot be earlier than the day you sign, and a phone call or a spoken wish is not enough on its own: the rule asks for a signed statement (42 CFR 418.28).

The hospice team helps with the paperwork whether or not it agrees with the decision. A hospice cannot refuse to let you leave, and it cannot make you give a reason.

What happens to Medicare coverage when you revoke?

Regular Medicare coverage, Part A and Part B, starts again on the date you choose. If you have a Medicare Advantage plan, it was never cancelled: it pays again for the care it covers. Medicines go back to your Part D plan or your usual coverage.

What you give up is the rest of that hospice benefit period. The equipment the hospice brought, such as the hospital bed and oxygen, is picked up, and the hospice stops its visits and its 24-hour line on the effective date. Ask the team what to arrange before that day, for example who will manage symptoms and where prescriptions will come from.

Can you go back on hospice after leaving?

Yes. You elect hospice again with a new signed election, and a doctor certifies again that life expectancy is six months or less if the illness runs its usual course. The next benefit period begins where you left off: if you revoked during the first 90-day period, the second 90-day period comes next; after the two 90-day periods, each new period is 60 days. Read how long Medicare pays for hospice.

You can also go back to a different hospice. Any Medicare-certified hospice that serves your address can admit you.

Why do people leave hospice?

The common reasons, plainly. One of them is not a reason to revoke.

• To try a treatment again. Chemotherapy, dialysis, surgery or a clinical trial that the person now wants. Treatment meant to cure the terminal illness is not covered while on hospice, so people revoke to pursue it, and some come back afterwards.
• A hospital stay the hospice did not arrange. If a person goes to the emergency room and is admitted for the terminal illness without the hospice's involvement, the hospital may ask for a revocation so that Medicare can pay the hospital. Call the hospice first, at any hour: many admissions can be arranged under hospice instead.
• A move. The person moves somewhere the hospice does not serve. That is usually a transfer to another hospice, not a revocation.
• A change of mind. The person or the family is not ready. That is allowed, and the door stays open.
• Wanting a different hospice. This is not a reason to revoke. You can change hospices once per benefit period without losing a day of coverage. Read switching hospice providers.

What is the difference between revocation, transfer and discharge?

Three different things that families hear about together.

A hospice may discharge a person only for the reasons in the rule: the person is no longer terminally ill, moves out of the service area, or for cause after the steps the rule requires (42 CFR 418.26).

What is "graduating" from hospice?

Graduating is the everyday word for a live discharge because the person is no longer certified as terminally ill. It happens: some people stabilize or improve with good symptom care. Before it, the hospice must tell the person and family, write a discharge plan, and arrange the care that will follow. Afterwards, regular Medicare pays as before.

If the illness progresses again, the person can be referred and certified again. Nothing about a discharge counts against a later election.

What should you ask before you revoke?

• What treatment are we going back for, and has the doctor giving it agreed to the plan?
• Who manages pain and other symptoms starting tomorrow, and where will the prescriptions come from?
• What happens to the hospital bed, the oxygen and the comfort medicines, and on which day?
• If this does not go the way we hope, can we come back, and how quickly?

Common questions about leaving hospice

Read more

Switching hospice providers, how long Medicare pays for hospice and what hospice won't tell you.