Can You Switch or Fire Your Hospice Provider?

Yes. You can switch hospices, and you can fire one. Medicare lets a patient or representative change to a different Medicare-certified hospice once in each benefit period (42 CFR 418.30). That change is a transfer: you stay on hospice, in the same benefit period, with no penalty and no gap in coverage as long as both hospices use the same date. To fire a hospice without replacing it, you revoke the hospice benefit in writing, which you can do at any time. You do not need the current hospice's permission for either. If the team isn't responsive, the on-call line doesn't answer, or symptoms aren't being managed, these are your ways out.

Switching is not the same as quitting hospice

This is the key distinction. Transferring, also called switching or changing hospice agencies, means staying on hospice but changing which company provides it. CMS treats a change of hospice as a transfer, not a revocation, and the patient continues in the same benefit period. Revoking means leaving hospice entirely and returning to standard Medicare coverage.

	Transfer (switch agency)	Revoke (leave hospice)
What changes	Which agency provides hospice	You stop hospice; standard Medicare coverage resumes
Benefit period	Stays intact, same dates	You forfeit the unused days in the current period
How it's done	Signed statement filed with both hospices	Signed statement filed with the hospice; a verbal revocation is not accepted
Effective date	The date you name, the same for both hospices	The date you name, no earlier than the day you revoke
How often allowed	Once per benefit period	Anytime
Coming back	Does not apply; you never left	No waiting period if the patient still qualifies; the next benefit period begins

If your problem is the company, transfer. Revoking ends hospice coverage on the date you name, including the hospice's nurses, on-call line, comfort medications, and equipment, so arrange other care before you sign. If your goal is to pursue curative treatment, that is a revocation, a different decision entirely; see leaving hospice to resume treatment.

How transferring to another hospice works

• Pick the new hospice first. Find a Medicare-certified agency that serves your area, tell it you want to transfer, and get its agreement and a start date before you leave the current one.
• Sign the statement. It names the current hospice, the new hospice, and the date the change takes effect, and it is filed with both (42 CFR 418.30). The patient signs, or a representative with authority under state law if the patient cannot. Ask the new hospice to help with the form.
• Use one date for both hospices. The old hospice stays responsible through the effective date, and the new hospice's care starts on that same date. If the dates do not match, Medicare does not treat it as a transfer (Medicare Claims Processing Manual, ch. 11, sec. 20.1.3).
• The new hospice notifies Medicare. It files the transfer notice after the change. You file nothing with Medicare yourself.
• Care hands over. The old hospice must send the new one a discharge summary with the current plan of care and latest physician orders, plus the clinical record if requested (42 CFR 418.104). The new hospice must do its own assessments; the first is due within 48 hours, and you can ask for it sooner (42 CFR 418.54). The new hospice becomes responsible for medications and equipment, so ask both agencies who delivers, picks up, and refills each item.

The full checklist is in how to switch hospice providers.

What if you already switched this benefit period?

You cannot make a second transfer in the same benefit period; CMS says later transfers within a period are not permitted. You have two options:

• Wait for the next benefit period. The right renews in each one. Periods run 90 days, then 90 days, then an unlimited number of 60-day periods (see hospice benefit periods).
• Revoke, then elect hospice again with a different agency. CMS says there is no waiting period after a revocation, and a new benefit period can begin immediately if the patient still qualifies. The trade-offs: you lose the days left in the current period, and the new hospice needs a new election and certification, plus a face-to-face encounter if the new period is the third or later. Get the new hospice's agreement and dates first so no day falls between the two.

When switching is the right call, and when to fix it first

Good reasons to switch include an after-hours line that doesn't get a nurse to you, repeated missed visits, poorly controlled pain or breathlessness, or a hospice that can't provide a level of care you need (such as inpatient crisis care). But many issues, including missed visits, slow callbacks, and uncontrolled symptoms, can be fixed faster by escalating within the current agency: ask for the clinical manager or medical director and state the problem plainly. You can also ask for a different nurse or aide without leaving. Our guide on what to do if you're unhappy with your hospice walks through raising concerns before, or instead of, leaving. If the agency still cannot deliver, transfer.

What to confirm about the new agency before you move

A transfer only helps if the replacement is genuinely better, so vet it the way you would a first choice:

• After-hours responsiveness — ask specifically how fast a nurse can reach the bedside at night and on weekends.
• Access to higher levels of care — confirm they can provide General Inpatient and continuous home care during a crisis.
• Service to your location — if your loved one is in a nursing home, confirm the new hospice has the written agreement with that facility that Medicare requires; in assisted living, verify it serves that building.
• Quality signals — review CMS Care Compare and family-survey (CAHPS) scores.
• Continuity — ask whether you'll have a consistent assigned nurse rather than a rotating cast.
• What it will not cover — ask for its written list of items, services, and drugs it treats as unrelated to the terminal illness, since that decision is the hospice's.

Can a hospice fire you?

Only for limited reasons. A hospice may discharge a patient who moves out of its service area or transfers, who it determines is no longer terminally ill, or “for cause” under its own policy, when the behavior of the patient or others in the home is so disruptive, abusive, or uncooperative that delivery of care, or the hospice's ability to operate effectively, is seriously impaired. Before a for-cause discharge it must warn the patient, make a serious effort to resolve the problem, and document it (42 CFR 418.26). A hospice cannot revoke your election. The Medicare Benefit Policy Manual also says it may not discharge someone at its discretion because care is costly or inconvenient, and it should not request or demand that a patient revoke. If the hospice says the patient no longer qualifies, you can ask for a fast review; see live discharge explained.

The misconception, corrected

Many families believe: “Once you sign with a hospice, you're locked in” or “changing hospices means losing Medicare coverage or starting the clock over.” Not true. You are not locked in, you don't lose the benefit, and a transfer continues in the same benefit period. Fear of being “stuck” should never keep a family with a hospice that isn't delivering.

Frequently asked questions

Can you transfer to a different hospice company at any time?

Yes, if you have not already changed hospices in the current benefit period. The rule sets no waiting period and does not require a reason; it requires only the signed statement filed with both hospices.

Will I lose coverage during a transfer?

No, as long as the new hospice's first day is the old hospice's last day. That is why you line up the new hospice before signing. The benefit continues in the same period.

Does a transfer restart the benefit period or mean re-qualifying?

It does not restart anything: the benefit period dates stay the same. The new hospice does its own assessments, and if the patient is in the third or later benefit period, a new face-to-face encounter is not required as long as the new hospice can verify the old one did it.

How many times can I switch?

Once per benefit period. The right renews with each new period, so a long stay can include more than one change, but a second transfer in the same period is not permitted.

Do I need my current hospice's permission to leave?

No. Switching is the patient's (or representative's) choice. The rule asks for a signed statement filed with both hospices, not approval.

Does it count as a switch if our hospice is sold or we move to another branch?

No. CMS says a change of ownership is not a change in the patient's designated hospice and requires no action from the patient. Moving to another location of the same hospice is not a transfer either. You keep your one change if you later want to leave.

What if we are moving to another area?

Transfer to a hospice that serves the new address, using the same effective date, and the benefit period continues. If the old hospice cannot arrange care until you arrive, it may discharge the patient instead, which ends the benefit period and means electing hospice again at the new hospice. See hospice travel and moves.

Do these rules apply if I have Medicare Advantage, Medicaid, or private insurance?

These are Medicare's rules. They apply with Medicare Advantage too, because Original Medicare covers hospice once it is elected. If Medicaid or a private plan is paying, ask that plan how it handles a change.

Practical next steps

• Compare alternatives objectively. Compare hospices near you and review each agency's CMS Care Compare and family-survey (CAHPS) scores before you move — see how to read a Care Compare star rating.
• Use a clear checklist when vetting the replacement: our 10-step guide to choosing a hospice covers after-hours coverage, GIP access, and responsiveness.
• Document your concerns with the current agency in case you decide to escalate first.

Bottom line: the choice is yours, and you should use it if the care isn't meeting the moment.