Medicare hospice benefit periods: 90 days, 90 days, then 60, explained

Not clinically reviewed. Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

Medicare hospice runs in benefit periods: an initial 90-day period, a second 90-day period, then an unlimited number of 60-day periods. Each period needs a written certification of terminal illness. From the third period on, a hospice physician or hospice nurse practitioner must also hold a face-to-face encounter no more than 30 days before recertification.

Key facts - Hospice periods run 90 days, 90 days, then any number of 60-day periods, in that order (42 CFR 418.21, checked Nov. 9, 2026). - Every period needs a written certification; a recertification can be signed no more than 15 calendar days before the next period starts (42 CFR 418.22, checked Nov. 9, 2026). - From the third period on, a hospice physician or hospice nurse practitioner must see the patient face to face within 30 calendar days before each recertification (42 CFR 418.22(a)(4)). - Telehealth is allowed for that encounter through Dec. 31, 2027, with limits that began Jan. 31, 2026 (FY 2027 hospice final rule, Aug. 3, 2026).

Families often first hear the phrase "benefit period" when a hospice nurse mentions a recertification visit, or when a patient is told they're "in their third period." It sounds like a time limit. It isn't one, exactly. Benefit periods are the blocks of time Medicare uses to decide when a hospice has to confirm, again, that a patient still qualifies. This guide walks through the periods, the paperwork deadlines tied to them and the face-to-face visit that starts with the third period.

How do Medicare hospice benefit periods work?

Under 42 CFR 418.21 (eCFR, checked Nov. 9, 2026), a person can elect hospice for:

1. an initial 90-day period,
2. a second 90-day period, and
3. an unlimited number of 60-day periods after that.

The periods are used in that order. Medicare.gov (checked Nov. 9, 2026) describes it the same way: two 90-day benefit periods, then an unlimited number of 60-day benefit periods, with Part A covering hospice for people who qualify.

A single election keeps running from one period into the next without a new election form, as long as the patient stays in hospice care, doesn't revoke and isn't discharged (42 CFR 418.24(f), checked Nov. 9, 2026). What does restart each period is the certification: the hospice has to get a written certification of terminal illness for every period, "even if a single election continues in effect" (42 CFR 418.22(a)(1)).

Here is how the days add up for someone who stays in hospice without a break. This is simple arithmetic from the 90/90/60 rule, counting the first day of the election as day 1:

A hospice stay doesn't end because a period ends. The six-month figure people hear relates to the prognosis a physician certifies (a life expectancy of 6 months or less if the illness runs its normal course, under 42 CFR 418.22(b)(1)), not to a cap on days. Medicare.gov says that after 6 months, a person can keep getting hospice care as long as the hospice medical director or hospice doctor recertifies, after a face-to-face meeting, that they're still terminally ill.

Who certifies each period?

For the first 90-day period, 42 CFR 418.22(c) requires certification from two people: the hospice medical director, a physician designee or the physician member of the hospice team, plus the patient's own attending physician if they have one. For every later period, only the hospice-side physician is required.

Each certification or recertification has to be signed and dated and must list the benefit period dates it covers. It also needs the physician's brief narrative, in their own words, explaining the clinical findings behind the prognosis (42 CFR 418.22(b)). From the third period on, that narrative must also explain why the findings from the face-to-face encounter support a life expectancy of 6 months or less.

When is recertification due?

There are two timing rules in 42 CFR 418.22(a)(3) (checked Nov. 9, 2026):

• Earliest: a recertification may be completed no more than 15 calendar days before the next benefit period starts. (The first certification can likewise be done up to 15 calendar days before the election takes effect.)
• Latest fallback: if the hospice can't get the written certification within 2 calendar days after a period begins, it must get an oral certification within those 2 days, and still have the written one before it bills Medicare for that period.

Using the table above, the recertification for the third period (starting day 181) could be signed as early as 15 calendar days before day 181. CMS's Medicare Benefit Policy Manual, chapter 9 (section 20.1, Rev. 13664, issued March 5, 2026) repeats the same 15-day and 2-day rules and says a written certification must be on file before the hospice submits a claim.

When is a hospice face-to-face encounter required?

Starting with the third benefit period, a hospice physician or hospice nurse practitioner must see the patient in a face-to-face encounter before each recertification. Under 42 CFR 418.22(a)(4)(i), the encounter must happen before, but no more than 30 calendar days before, the third-period recertification and every recertification after that. Its purpose, in the rule's words, is to gather clinical findings to determine continued eligibility. CMS's hospice page (checked Nov. 9, 2026) says the recertification for the third period and every one after it must document the encounter.

This is the hospice recertification encounter. It is a different requirement from the face-to-face rules for home health, and it applies to "total stay across all hospices," so time at an earlier hospice counts toward reaching the third period.

CMS's Benefit Policy Manual (section 20.1, checked Nov. 9, 2026) fills in several practical details:

• Who can do it: a hospice physician (employed by or under contract with the hospice) or a nurse practitioner employed by the hospice. Physician assistants, clinical nurse specialists and outside attending physicians can't.
• Timing: an encounter on the first day of the benefit period still counts as timely.
• New admissions already in a later period: if a hospice newly admits someone who is in the third or later period and documented exceptional circumstances (such as an emergency weekend admission) prevent an earlier visit, an encounter within 2 days after admission is considered timely.
• Paperwork: the physician or nurse practitioner who did the visit must attest to it in writing, with the date of the visit, their signature and the date signed (also required by 42 CFR 418.22(b)(4)).
• If it's missed: a recertification missing a required encounter is not complete, and CMS notes the law requires a complete recertification for Medicare to cover and pay for hospice services.

Can the face-to-face be done by telehealth?

Yes, with limits. The FY 2027 hospice final rule (91 FR 49118, published Aug. 3, 2026, effective Oct. 1, 2026) rewrote 42 CFR 418.22(a)(4)(ii) to match section 6209(f) of the Consolidated Appropriations Act, 2026. As the eCFR text read on Nov. 9, 2026:

• How long: when the encounter is only for hospice recertification, it may be done by telehealth through Dec. 31, 2027, or during a public health emergency if that runs later.
• What counts: two-way, real-time audio and video between the patient and the hospice physician or nurse practitioner.
• When telehealth is barred: beginning Jan. 31, 2026, telehealth can't be used if the patient is in an area under a hospice enrollment moratorium, if the patient's hospice is under enhanced oversight, or if the physician or nurse practitioner is neither enrolled in Medicare nor an opt-out practitioner.
• Claims: for encounters on or after Jan. 1, 2027, hospices must report telehealth encounters on the claim, following CMS guidance.

Families don't need to manage any of this, but it's reasonable to ask the hospice whether the next recertification visit will be in person or by video.

What happens to benefit periods if a patient leaves hospice?

It depends on how they leave. The periods don't reset in any of these cases.

• Revoking (choosing to stop): under 42 CFR 418.28, a patient or representative can revoke at any time with a signed, dated statement. Hospice coverage ends for the rest of that period, Medicare coverage of the benefits waived when hospice was elected resumes, and the person may elect hospice again for any other periods they're eligible for. The Benefit Policy Manual (section 20.2.2) says the remaining days in that period are forfeited and there is no waiting period to elect again.
• Discharge by the hospice: the Benefit Policy Manual (section 20.2.3) says a discharged patient loses the remaining days in that benefit period, at no added cost to them, and may elect hospice again later with no waiting period if they qualify.
• Switching hospices: a transfer is not a revocation. The Benefit Policy Manual says the benefit period doesn't change in a transfer, and a patient in the third or later period doesn't need a new face-to-face encounter if the new hospice can verify the first hospice had one. Medicare.gov says you can change hospice providers once during each benefit period. Our guide to changing hospices, stopping hospice or being discharged covers the paperwork and appeal rights for each.

Because periods are used in order (42 CFR 418.21), someone who leaves during their second period and later returns would pick up with a third, 60-day period, which brings the face-to-face requirement with it. Transfers between hospices also affect Medicare's long-stay claim checks; see our story on hospice long-stay edits returning in April 2027, which now carve out transfers.

Did the Nov. 9, 2026 home health rule change any of this?

No. We checked the CY 2027 home health final rule, CMS-1844-F (91 FR 72022, published Nov. 9, 2026). It amends 42 CFR parts 405, 410, 414, 422, 423, 424, 484 and 498, not the hospice rules in part 418. It finalizes a new ground for denying a hospice's Medicare enrollment tied to its medical director or administrator (42 CFR 424.530(a)(20)), and the rule says that provision does not change hospice policies in part 418. The last change to the benefit-period and face-to-face text was the FY 2027 hospice rule's telehealth update described above; 418.21 itself was last amended in 2005, according to eCFR.

What should families ask the hospice?

• Which benefit period is my loved one in now, and when does the next one start? Recertifications must list the period dates they cover, so the hospice has them.
• Will there be a face-to-face visit before the next period, who will do it, and will it be in person or by video?
• If we stop hospice or switch providers, what happens to the current period?
• What won't you cover? Medicare.gov says you can ask for an addendum to the election statement listing items, services and drugs the hospice considers unrelated to the terminal illness. Our story on the now-mandatory election statement addendum explains the rule for elections from Oct. 1, 2026. For what kind of care the hospice provides on a given day, see our guide to the four levels of hospice care.

Frequently asked questions

Is there a limit on how long someone can receive Medicare hospice? There is no cap on the number of periods. 42 CFR 418.21 allows an unlimited number of 60-day periods after the first two 90-day periods, as long as the hospice obtains a certification of terminal illness for each one.

Who can do the hospice face-to-face encounter? A hospice physician or hospice nurse practitioner (42 CFR 418.22(a)(4)). CMS's Benefit Policy Manual says the nurse practitioner must be employed by the hospice, and that physician assistants, clinical nurse specialists and outside attending physicians can't perform it.

If someone stops hospice, can they come back? Yes, if they still qualify. Under 42 CFR 418.28, a person who revokes can elect hospice again for any other election periods they're eligible for. CMS's Benefit Policy Manual says there is no waiting period. The days left in the period they left are lost.

How early can a recertification be signed? No more than 15 calendar days before the next benefit period starts (42 CFR 418.22(a)(3)(iii)).

Does switching hospices restart the benefit periods? No. CMS's Benefit Policy Manual says the benefit period doesn't change when a patient transfers to another hospice. If the patient is in the third or later period, the new hospice doesn't need a new face-to-face encounter if it can verify the first hospice did one.

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Sources were opened and checked Nov. 9, 2026. Rules and coverage can change; the linked primary sources control. Home Health Brief corrects errors under its published corrections policy.

This item has not been clinically reviewed. It is general information, not clinical, billing or legal advice.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards. Read how we use AI, our editorial policy and our corrections policy.