Can You Go Back to Home Health Care If You Leave Hospice?

Yes. Leaving hospice does not close the door on Medicare home health care. When a patient revokes hospice or is discharged alive, federal rules say Medicare coverage for the benefits they waived comes back, and that includes home health. But home health has its own entry test: the person must be homebound and need part-time or intermittent skilled care ordered by a doctor or other allowed practitioner. If they meet it, they can switch; if they don't, the obstacle is the home health rules, not the fact that they were once on hospice.

Why choosing hospice is not a one-way door

Families often hesitate because hospice feels like a bigger, more permanent decision than "just" home nursing. It is a different decision, because electing hospice means giving up Medicare coverage for curative treatment of the terminal illness. But it is reversible:

• Revocation (42 CFR 418.28). The patient or their representative can revoke hospice at any time by filing a signed statement with the hospice. The effective date cannot be earlier than the day the revocation is made. After revoking, Medicare coverage resumes for the benefits waived at election, and the patient can elect hospice again later for any election period they are still eligible for. The rest of the current election period is given up. See can you leave hospice and resume treatment.
• Live discharge (42 CFR 418.26). If the hospice determines the patient is no longer terminally ill, it discharges them, with a physician's discharge order. The effect is the same: the waived Medicare benefits resume and the patient may elect hospice again if they become eligible. See can you be discharged from hospice for getting better.

Home health has its own entry test

Medicare.gov and the certification rules (42 CFR 424.22) require all of the following before Medicare pays for home health:

• Homebound. Leaving home is not recommended, or is hard without help, and the person is normally unable to leave and doing so takes a lot of effort. Medical appointments and short non-medical outings, such as religious services, are allowed.
• A skilled need. The person needs intermittent skilled nursing, physical therapy, or speech-language pathology. Occupational therapy can continue a home health stay but cannot start one on its own.
• A face-to-face encounter with a doctor or other allowed practitioner (it can be by telehealth), related to the main reason for home health, no more than 90 days before or within 30 days after the start of care.
• An order and a plan of care from the doctor or allowed practitioner, with the person under their care.
• A Medicare-certified home health agency to provide the care.

The homebound and skilled-need tests are where people leaving hospice most often fall short. Someone who has stabilized and is getting out more may no longer be homebound, and someone who mainly needs help with bathing and dressing has a custodial need, not a skilled one. Medicare does not cover custodial care when it is the only care needed.

What changes when you move from hospice to home health

	Hospice	Medicare home health
Who qualifies	Prognosis of 6 months or less if the illness runs its normal course	Homebound, with an intermittent skilled need
Treatment for the terminal illness	Comfort-focused; curative treatment waived	No waiver; curative care is covered under regular Medicare
Aide visits	Part of the hospice plan of care	Part-time or intermittent, only while skilled services are also being received
Drugs	Pain and symptom drugs, copay of up to $5 per prescription	Back to your regular drug coverage
Cost of the visits	Little or nothing for covered hospice care	$0 for covered home health services; 20% of the Medicare-approved amount for durable medical equipment after the Part B deductible

Medicare home health does not pay for 24-hour care at home. Hospice also does not provide round-the-clock care as a routine matter, though it can provide continuous nursing care at home for short periods during a medical crisis. The broader comparison is in hospice vs. home health care: key differences.

How to make the hand-off smooth

• Line up the home health order before the revocation date. Ask the doctor who will follow your loved one to confirm they will order home health and complete or document the face-to-face visit, and pick an agency that will accept the referral.
• Choose the revocation date deliberately. The effective date on the signed statement cannot be backdated, so time it so there is no gap between the last hospice visit and the first home health visit.
• Ask for discharge planning if the hospice is discharging. For patients discharged because they are no longer terminally ill, federal rules require the hospice's discharge planning to include any needed family counseling, patient education, or other services before discharge.
• If you have Medicare Advantage, CMS says Original Medicare keeps paying through the end of the month in which hospice ends, and coverage returns to the plan at the start of the next month. Check that the home health agency works with the plan for the months ahead.

If you need hospice again

Coming off hospice now does not stop your loved one from returning. As long as a physician again certifies a prognosis of six months or less, they can re-elect hospice with the same agency or a new one. See can you go back on hospice after discharge.

Frequently asked questions

Is it a big decision to enter hospice rather than home nursing care?

It is a meaningful one, because hospice waives Medicare coverage for curative treatment of the terminal illness. But it is not permanent. Revoking restores that coverage, and if your loved one meets the home health rules, home health is available again.

Do we have to give a reason to leave hospice?

No. The rule lets a patient or representative revoke at any time with a signed, dated statement filed with the hospice.

Will home health send someone every day, the way we hoped?

Home health covers part-time or intermittent visits, not 24-hour care, and aide help only while skilled services are also being provided. If your loved one needs ongoing hands-on help, plan for family or paid caregivers alongside home health.

Does home health cost more than hospice?

For the visits themselves, usually not. Medicare.gov says you pay nothing for covered home health services. Equipment is different: you pay 20% of the Medicare-approved amount after the Part B deductible.

What to do next

If you are weighing hospice but fear the choice is final, ask the hospice and your doctor to walk through what a return to home health would look like for your loved one, including whether they would meet the homebound and skilled-need tests. When you are ready to choose a provider, compare hospices near you on quality and family-survey scores.