How to Read a Hospice's CMS Care Compare Star Rating

A hospice's star rating on Medicare's Care Compare is its "Family caregiver survey rating": one to five stars summarizing what family caregivers reported on a national survey after the patient died. More stars mean caregivers reported a better experience than at lower-rated hospices. The star does not cover clinical quality, inspections, or whether the hospice serves your address. To read it, check whether there is a star at all (about two in three hospices have none), open the seven percentages behind it, and compare each one with the state and national averages shown beside it. This directory shows those percentages and each hospice's ownership so you can read them side by side; our copy can lag Medicare's, so treat Care Compare as the final word.

What each star level means, and what counts as good

The stars compare hospices with one another on caregiver experience; they are not a pass or fail. Medicare says a 1-star rating doesn't mean you'll get poor care from that hospice. It means hospices with 2 or more stars did better on these particular survey measures. CMS also doesn't force a set share of hospices into each level, which is why the levels are uneven. Here is how the 2,164 rated hospices fall in the current cycle (the August and November 2026 refreshes):

Stars	Hospices	Share of rated hospices
5	417	19%
4	883	41%
3	632	29%
2	198	9%
1	34	2%

So 4 stars is the most common result nationally, and 60% of rated hospices hold 4 or 5 stars. Nationally, a 3-star hospice is below the typical rated hospice, but not everywhere: in California, Florida, and New Jersey, for example, the middle rated hospice has 3 stars.

What goes into the star

Only the family caregiver survey. The star comes from the CAHPS Hospice Survey, which goes out about two months after the month of death to the family member or friend who knew the most about the patient's hospice care. In the current cycle it uses seven measures:

• Communication with family
• Getting timely help, including on evenings, weekends, and holidays
• Treating the patient with respect
• Emotional and spiritual support
• Help for pain and symptoms
• Rating of this hospice
• Willingness to recommend this hospice

Each score is the share of caregivers who gave the most favorable answer, adjusted for the mix of patients the hospice serves and for how the survey was given. CMS turns each score into a star level using set score ranges, called cut points, then averages the levels and rounds to a whole star. The two overall measures, rating and recommend, count as half a measure each, so a high "would recommend" can't carry a rating by itself. Care Compare publishes only the final star, not the level for each measure, but you can look up the levels yourself:

Measure (% giving the best answer)	5 stars	4 stars	3 stars
Communication with family	88+	83-87	79-82
Getting timely help	84+	79-83	74-78
Treating the patient with respect	94+	92-93	88-91
Emotional and spiritual support	93+	91-92	88-90
Help for pain and symptoms	82+	76-81	71-75
Rating of this hospice	88+	83-87	78-82
Willingness to recommend	90+	84-89	78-83

A score below the 3-star range earns 1 or 2 stars. These are CMS's cut points for the August and November 2026 refreshes; it recalculates them every six months.

One measure is on hold. CMS revised the survey for patients who died from April 2025 on, so "Training family to care for patient" isn't being reported right now. CMS expects it back, along with a new Care Preferences measure, with the February 2028 refresh, when the star will rest on nine measures.

Why a hospice has no star

It had too few completed surveys. A hospice needs at least 75 over the eight-quarter reporting period, because CMS says a rating built on fewer doesn't have the statistical reliability to separate one hospice from another. In the August 2026 data, 4,505 of 6,669 hospices had no star, and 3,465 of them showed no survey percentages either. Unrated hospices tend to be small: CMS says 88% of Medicare patients who died in hospice care in 2024 were in a hospice that got a star. Medicare is clear that a missing rating doesn't mean something is wrong with the hospice.

Not every blank means the same thing, though. Care Compare prints a small footnote number beside "Not available" and beside some scores, and that number tells you why:

What you see	What it actually means	What to do
4 stars overall	A summary of seven survey measures, from at least 75 completed surveys	Open the percentages beneath it
No star (footnote 15), but percentages shown	30 to 74 completed surveys: enough to publish percentages, too few for a star	Read the percentages against the averages
"Not available" with footnote 6	Too few completed surveys to publish the percentage	Lean on the quality measures and your own interview
"Not available" with footnote 11	Too new or too small to be required to take part in the survey, or no cases met the criteria. This is the most common blank	Same, and see newly certified hospices
"Not available" with footnote 10	The hospice submitted none of the required survey data	Ask why; this is not a sample-size issue
A score with footnote 9	There were discrepancies in how the survey data were collected	Ask the hospice what happened
High "would recommend"	Families were satisfied overall	Still check "timely help" separately
Score vs. state average	Whether performance is strong or just typical	Compare each measure to the average shown

How to read the stars without being misled

• Look past the single star to the percentages. The star sits under the hospice's name on its profile; open "Family caregiver experience" under Quality to see what's behind it. Two hospices can share a star but differ sharply on "getting timely help" or "help for pain and symptoms," the things you'll feel at 2 a.m.
• Don't look for a survey count. Care Compare doesn't print how many surveys came back, so use the table above: a star means at least 75, and percentages without a star mean 30 to 74.
• Compare to state and national averages, which Care Compare shows beside each percentage, so you know whether a score is strong or just average.
• Check how old the data is. Stars are recalculated every six months from eight quarters of surveys, and the current ones describe patients who died between October 1, 2023 and September 30, 2025. That is a rear-view mirror, not a live feed, so pair the star with current questions to the agency about staffing, after-hours coverage, and whether they serve your exact location today.

A worked example: same star, different reality

Imagine two four-star hospices on your shortlist (the hospices are invented; the cut points are CMS's). Hospice A scores 85% on getting timely help, the 5-star level, and sits at the 4-star level on everything else. Hospice B scores 72% on timely help, the 2-star level, but reaches the 5-star level on communication, respect, emotional support, and pain, and the 4-star level on rating and recommend. Averaged CMS's way, A comes to 4.17 and B to 4.33, and both round to four stars. If your loved one is likely to have nighttime breathing crises, read both numbers: Hospice A is 13 points ahead on getting timely help, which covers evenings, weekends, and holidays, while Hospice B is a star level ahead on help for pain and symptoms, which covers trouble breathing. The headline number alone would have hidden that.

What the star leaves out

Clinical measures, inspections, and anything specific to your family. Under "Quality of patient care," each Care Compare profile shows three measures that don't feed the star (national averages are from the August 2026 refresh):

• Hospice Comprehensive Assessment Measure: the share of patients who got all 7 care processes Medicare tracks at the start of hospice care, such as checking for pain and shortness of breath. National average: 96.2%.
• Hospice Visits in the Last Days of Life: the share of patients visited by a registered nurse or medical social worker on at least 2 of their final 3 days. National average: 48.3%.
• Hospice Care Index: a 0-to-10 score built from 10 indicators, such as skilled nursing visits, discharges followed by hospitalization, and spending per patient. National average: 8.8.

See what hospice quality measures actually tell you and what the Hospice Care Index is. Inspection findings aren't on the profile at all; our guide to hospice accreditation explains where to read them.

The survey has its own limits. It covers only patients who died in hospice care after at least 48 hours there, so families of patients who left hospice alive aren't asked, and CMS reports a 30% response rate for deaths in 2024 and 2025. Ratings also won't tell you whether this nurse will click with your family, whether the agency serves your exact address or facility, or whether they can provide a specific level of care (like inpatient crisis care) when you need it. Use Care Compare to build a shortlist, then ask the human questions in our 10-step guide to choosing a hospice: after-hours coverage, visit frequency, and GIP access. Each Medicare profile also links to its own checklist, "Suggested Questions to Ask When Choosing a Hospice."

The misconception, corrected

The common mistake is treating the headline star as a final verdict: "four stars, done." The star is a starting point. A four-star hospice with weak "timely help" scores or no coverage for your area may serve you worse than a carefully vetted three-star agency that excels where you need it. Equally, don't dismiss a provider solely because it has no star; most hospices don't have one. Read the percentages and the averages, then decide.

Looking for the "Hospice Compare" fact sheet?

Hospice Compare no longer exists, so fact sheets with that name are out of date. CMS retired the Hospice Compare site on December 1, 2020, and the same information moved to Care Compare on Medicare.gov. CMS's "Hospice Compare Website" fact sheet (2017) and "Updates to Hospice Compare for the May 2019 Refresh" also predate star ratings, which first appeared in August 2022. For current CMS documents, search for these titles:

• "CAHPS Hospice Survey Care Compare Data Refresh Schedule": a one-page fact sheet on when stars and percentages update.
• "Publicly Reported Hospice Characteristics based on Public Use File (PUF) Data": a fact sheet, updated May 2026, on the patient and service details shown on each profile.
• "Frequently Asked Questions About the CAHPS Hospice Survey Star Ratings" and "Technical Notes for CAHPS Hospice Survey Star Ratings": on hospicecahpssurvey.org, with the full method and current cut points.

Frequently asked questions

How often are Care Compare ratings updated?

Stars change every six months, with the February and August refreshes. The percentages beneath them change every quarter. Both use eight quarters of survey data, so they describe past patients. Confirm current details such as staffing, coverage, and availability directly with the agency before you enroll.

Is a hospice with no star rating a red flag?

Not by itself. About two in three hospices have no star, usually small or new agencies with fewer than 75 completed surveys. That means less public evidence, not poor care. Check the footnote on any "Not available" percentage, then rely more on the clinical quality measures and your own intake interview.

Why did a hospice's stars change when its scores barely moved?

CMS recalculates the cut points every six months as the oldest two quarters of data drop off and the newest two are added. A hospice with the same scores can land in a different star level if other hospices' scores rose or fell.

Does a rating apply to the whole hospice company?

No. CMS rates each hospice by its CMS Certification Number, not its brand. In the August 2026 data, 21 Texas hospices are listed under one brand name: 8 have stars, ranging from 2 to 5, and the other 13 are unrated. Make sure you are reading the one that would serve you; see how to verify a hospice is Medicare-certified.

Do stars tell me whether the hospice serves my address?

No. Ratings say nothing about service area. A highly rated hospice may not cover your home, neighborhood, or facility. Always confirm that the agency serves your exact location and setting.

Should ownership change how I read the rating?

Ownership (for-profit versus nonprofit) is one useful input, not a verdict. Read it alongside the measures rather than letting it decide for you; see nonprofit vs. for-profit hospice.

Practical next steps

• Build a shortlist by location. Compare hospices near you or browse a state page like Texas hospices to see hospices with an office in each city, with ownership and family-survey percentages shown per provider. An office nearby doesn't prove a hospice serves your address, and one based elsewhere may, so also search your address on Care Compare, which looks for hospices that serve your area.
• Open each provider's measures, not just the star: focus on timely help, symptom management, and "would recommend."
• Weigh ownership as one input, not the deciding factor.
• Call your top one or two and ask the questions ratings can't answer.
• Remember you're not locked in: if the reality doesn't match the rating, you can switch hospice providers once per benefit period.

Bottom line: read Care Compare as a shortlist tool, not a final grade. Look at the family-survey percentages and quality measures beneath the star, check the footnotes, compare to averages, and confirm the human details directly with the agency.