Changing hospices, stopping hospice or being discharged: your Medicare rights

Not clinically reviewed. Informational only, not medical, billing or legal advice. Check the linked primary source and talk with your care team and Medicare.

Medicare lets you change hospice providers once in each benefit period without losing coverage, by filing a signed statement with both hospices. You can stop hospice at any time and return later if eligible. If a hospice plans to discharge you, it must give written notice, and you can request a fast QIO review.

Key facts - Hospice runs in two 90-day benefit periods, then unlimited 60-day periods (42 CFR 418.21). - Switching hospices: allowed once per benefit period, and it doesn't end your hospice coverage (42 CFR 418.30). - Stopping hospice (revoking): allowed any time, with a signed, dated statement (42 CFR 418.28). - Discharge by the hospice: only for set reasons, with a physician's order (42 CFR 418.26). - Fast appeal: ask the QIO by noon the day after you get the discharge notice (42 CFR 405.1202).

These rules describe Original Medicare's hospice benefit. If you're in a Medicare Advantage plan, Medicare.gov says Original Medicare covers everything related to your terminal illness once hospice starts, even if you stay in your plan. For what hospice covers day to day, see our guide to the four levels of hospice care.

How do hospice benefit periods work?

Medicare hospice is organized in benefit periods (the rule calls them election periods): an initial 90-day period, a second 90-day period, and then an unlimited number of 60-day periods, under 42 CFR 418.21. The periods come in that order and can be used at different times.

The hospice must get a written certification that the patient is terminally ill for each period, under 42 CFR 418.22. From the third period on, a hospice physician or nurse practitioner must see the patient face to face within the 30 days before each recertification. The rule allows that visit by video, for recertification only, through at least Dec. 31, 2027.

Benefit periods matter because the right to switch hospices resets with each one.

Can I change hospice providers?

Yes, once in each benefit period. Medicare.gov says you have "the right to change your hospice provider once during each benefit period." Under 42 CFR 418.30, switching is not the same as stopping hospice, so your hospice coverage continues without a gap in the benefit period.

To switch, you or your representative file a statement with both the hospice you're leaving and the new one. It must include:

• the name of the hospice you've been getting care from,
• the name of the hospice you plan to get care from, and
• the date the change takes effect.

Medicare.gov notes that you can't get the same type of hospice care from a different hospice unless you formally change providers. You can keep the attending doctor or nurse practitioner you chose to help oversee your care.

Can I stop hospice care?

Yes, at any time. Under 42 CFR 418.28, you or your representative may revoke the hospice election by filing a signed statement with the hospice saying you're giving up hospice coverage for the rest of the current benefit period. The statement includes the date it takes effect, which can't be earlier than the day you sign.

When you revoke:

• Medicare stops covering hospice care for the rest of that benefit period.
• Medicare coverage you gave up when you chose hospice comes back, such as Part A and Part B coverage for treatment aimed at curing the terminal illness.
• You can choose hospice again later for any remaining benefit periods you're eligible for.
• The hospice must notify its Medicare contractor within 5 calendar days.
• If you're in a Medicare Advantage plan, Medicare.gov says your plan coverage starts again on the first day of the following month.

One trade-off: revoking ends the current benefit period early, and whatever days were left in it can't be used later. Switching providers keeps the period going. Our Nov. 1 story on hospice election letters covers what to do if you didn't mean to start hospice at all.

Can a hospice discharge me?

Only for one of three reasons listed in 42 CFR 418.26:

1. You move out of the hospice's service area, or transfer to another hospice.
2. The hospice decides you're no longer terminally ill. This is often called a "live discharge."
3. For cause. The patient's behavior, or that of others in the home, is disruptive, abusive or uncooperative to the point that care is seriously impaired. Before discharging for cause, the hospice must warn the patient, make a serious effort to fix the problem, make sure the discharge isn't because of the patient's use of necessary hospice services, and document all of it.

For any discharge, the hospice needs a written discharge order from its medical director or a physician on the care team, and your own attending physician should be consulted if one is involved. Hospices must also have a discharge-planning process, including family counseling and education, for patients whose condition stabilizes.

After a discharge, your regular Medicare coverage resumes, and you can elect hospice again if you become eligible.

What if I disagree with a hospice discharge?

You can ask for a fast, independent review. Under 42 CFR 405.1200, a hospice must give you a standardized written notice no later than 2 days before it ends your services. Under 42 CFR 405.1202, if you disagree with a hospice's decision to discharge you, you have the right to an expedited decision from the Quality Improvement Organization (QIO) in your state.

The deadline is short. You or your representative must ask the QIO, in writing or by phone, by noon of the day after you receive the notice. You can send information for the reviewer to consider, but you don't have to, and you need to be reachable for questions. Keep the notice: it is the document that starts this process.

Quick comparison

Frequently asked questions

How many times can I switch hospice providers? Once in each benefit period. Under 42 CFR 418.30, you or your representative file a statement with both hospices naming each one and the effective date. Switching is not a revocation, so hospice coverage continues.

If I stop hospice, can I go back to it later? Yes, if you still qualify. Under 42 CFR 418.28, revoking ends hospice coverage for the rest of the current benefit period, and you can elect hospice again for any remaining periods. Medicare.gov says you can go back to hospice care at any time if you qualify.

Why can a hospice discharge a patient? Only for three reasons under 42 CFR 418.26: the patient moves out of the service area or transfers hospices, the hospice determines the patient is no longer terminally ill, or for cause under a hospice policy with required steps.

How fast must I appeal a hospice discharge? By noon of the calendar day after you receive the hospice's notice of termination, in writing or by phone, to the Quality Improvement Organization, under 42 CFR 405.1202. The notice must come no later than 2 days before services end (42 CFR 405.1200).

Does Medicare Advantage change these rules? Medicare.gov says Original Medicare covers everything related to the terminal illness once hospice starts, even if you stay in your plan, and if you leave hospice your plan coverage starts again the first day of the following month.

Sources

• 42 CFR 418.21, election periods
• 42 CFR 418.22, certification of terminal illness
• 42 CFR 418.26, discharge from hospice care
• 42 CFR 418.28, revoking the election of hospice care
• 42 CFR 418.30, change of the designated hospice
• 42 CFR 405.1200, notifying beneficiaries of service terminations
• 42 CFR 405.1202, expedited determination procedures
• Medicare.gov, Hospice care

Sources were opened and checked Nov. 4, 2026. Rules and coverage can change; the linked primary sources control. Home Health Brief corrects errors under its published corrections policy.

Photo: Olu Eletu / Wikimedia Commons (via Unsplash), CC0 (cropped). A person signing a document; file photo from April 2015, illustration only.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards.