What Are Hospice Benefit Periods?

Medicare hospice benefit periods are two 90-day periods followed by an unlimited number of 60-day periods. Each period has to be certified by a hospice physician, who confirms the patient still has a life expectancy of six months or less if the illness runs its normal course. From the third period on, a hospice physician or nurse practitioner must also see the patient face to face before the period begins. As long as the patient stays eligible, the periods keep renewing; there is no maximum.

The benefit-period timeline

Federal rules (42 CFR 418.21) say the periods are used in that order. The day count follows the patient, not the agency: switching hospices does not restart you at a fresh 90-day period.

Hospice benefit period calculator: a worked example

To work out your own dates, start from the effective date of the hospice election and count forward. Here is an example for an election that takes effect on January 1, 2027:

Each later period starts the day after the previous one ends and runs 60 days. If the patient had earlier hospice days, including days with another agency, the hospice counts from those days, so ask the hospice which period the patient is in now. The hospice can check this in Medicare's records.

Key deadlines inside each period

Before October 1, 2026, a hospice had to provide the addendum only if the patient or family asked for it. For elections starting on or after that date, the FY2027 hospice rule makes it mandatory for every patient. Signing it only confirms you received it. It does not mean you agree, and you can ask the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for immediate advocacy if you disagree.

Hospice benefit periods vs. a Medicare Part A "benefit period"

These are two different things that share a name. A hospice benefit period is one of the 90- or 60-day certification windows described on this page. A Part A benefit period (for hospital and skilled nursing facility care) starts the day you are admitted as an inpatient and ends once you have gone 60 days in a row without inpatient hospital or skilled nursing care. Part A deductibles and day limits are tied to that kind of benefit period, not to hospice periods.

Who certifies each period

For the first 90-day period, two people certify: the hospice medical director or a hospice physician, and the patient's attending physician if the patient has one. For every later period, only the hospice physician has to certify. Each certification includes a short narrative, written by the physician, explaining the clinical findings that support a six-month prognosis. From the third period on, that narrative must also explain how the findings from the face-to-face visit support continued eligibility. This is a clinical judgment, reassessed each period, based on the documented course of the illness. Families do not test or score themselves. For how the renewal works, see what is hospice recertification and how often.

The face-to-face encounter

The face-to-face visit is required before the third benefit period and before each period after that. It must happen no more than 30 calendar days before the recertification, and a visit on the first day of the new period also counts. A hospice physician or a nurse practitioner employed by the hospice performs it. Physician assistants and outside attending physicians cannot. Through December 31, 2027, it may be done by real-time audio-video telehealth when it is only for recertification. Telehealth is not allowed if the patient is in an area under a Medicare moratorium on new hospice enrollment, if the hospice is under Medicare’s enhanced oversight, or if the practitioner is not enrolled in Medicare (and has not opted out). In those cases the visit must be in person. The purpose is to collect clinical findings for the certifying physician, much like a routine check-in. Learn more in what is a hospice face-to-face encounter.

The misconception to correct

Many families take "two 90-day periods" to mean that hospice lasts six months and then stops. It doesn't. The 90-day periods are only the first two windows. Because the 60-day periods after them are unlimited, hospice can continue for many months or longer if the prognosis still supports it. See does hospice kick you out after 6 months.

How benefit periods interact with the hospice cap

Benefit periods are about one patient's eligibility. The hospice aggregate cap is a separate limit on the hospice agency. For the FY2027 cap year (October 1, 2026 through September 30, 2027), the cap is $36,174.75 multiplied by the number of Medicare patients the hospice serves (up from $35,361.44 in FY2026). If the agency's total Medicare payments go over that limit, the agency repays the difference to Medicare. Individual patients do not "hit a cap," and the cap is not a reason Medicare uses to end an eligible patient's coverage.

Switching hospices during a benefit period

You have the right to change your hospice provider once in each benefit period (42 CFR 418.30). The change is not a revocation. You file a statement with both the old and the new hospice that names each one and gives the effective date of the change. Your current period continues with the new agency, and the day count carries over.

Revocation or discharge in the middle of a period

If the patient revokes hospice, or the hospice discharges the patient (for example, because the illness has stabilized and the physician can no longer certify a six-month prognosis), the remaining days in that benefit period are lost. Regular Medicare coverage for the illness resumes right away. There is no waiting period to come back: if the patient becomes eligible again, they can re-elect hospice, and the next benefit period in sequence can begin immediately. A revocation must be in writing and signed by the patient or representative. Only the patient or representative can revoke; a hospice cannot revoke a patient's election. See live discharge from hospice explained.

A simple decision path for families

• Just starting? The initial certification opens the first 90-day period, and care begins. Expect the election statement addendum within the first 5 days.
• Approaching day 90 or 180? A recertification is due. Most families barely notice it.
• Approaching day 180 or any 60-day renewal after it? Expect a face-to-face visit in the 30 days before the new period. It is routine.
• Told a discharge is coming? Ask for the reason in plain terms, and remember the patient can re-elect if they become eligible again.
• Unhappy with the agency? You can switch once per benefit period without losing coverage. See how to switch hospice providers.

Frequently asked questions

How long is each hospice benefit period?

The first two are 90 days each. Every period after that is 60 days, with no limit on how many you can have.

Is there a maximum number of benefit periods?

No. After the two 90-day periods, the 60-day periods are unlimited. Hospice continues as long as a hospice physician recertifies the terminal prognosis at the start of each period and the face-to-face requirement is met.

How do I calculate which benefit period my loved one is in?

Count forward from the effective date of the hospice election, with that date as day 1. Days 1–90 are the first period, 91–180 the second, 181–240 the third, and each later period adds 60 days. Earlier hospice stays, including stays with other agencies, count too. The hospice can confirm the current period and the next recertification date.

Does the six-month estimate mean coverage ends at six months?

No. "Six months or less if the illness runs its normal course" is the prognosis needed to qualify. It is not an expiration date. Many people outlive it and stay on hospice as long as they continue to be recertified.

Do I have to do anything for recertification?

Usually not. The hospice team documents the patient's current condition and the hospice physician signs the recertification. When a face-to-face visit is due, the hospice schedules it. The main thing you can do is tell the team about changes in the patient's condition.

What if I switch hospices: does my benefit period reset?

No. Your current period and accumulated days carry over to the new provider. You can switch once in each benefit period.

Is there an out-of-pocket cost tied to benefit periods?

Starting or renewing a period costs nothing. Under Original Medicare, the hospice benefit can include a copayment of up to $5 per prescription for outpatient drugs for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care. Medicare does not cover room and board when hospice care is given at home, in a nursing home, or in a hospice inpatient facility, except for short-term inpatient or respite stays that the hospice arranges.

Practical next steps

• Ask the hospice which benefit period the patient is in and when the next recertification is due.
• Check that you received the election statement addendum (the list of what the hospice won't cover) within the first 5 days, if the election began on or after October 1, 2026.
• Expect the face-to-face encounter before the third period and every period after it.
• If you want to change agencies, you can do so once per benefit period.
• Read the full mechanics in how long you can stay on hospice.
• Comparing options? Compare hospices near you and ask how each one handles recertification and face-to-face visits.

If hospice has not started yet, ask a hospice for an evaluation. The physician's certification opens the first benefit period.