Can you leave hospice? Stopping, getting better and coming back

The hardest part of saying yes to hospice is often the feeling that it can’t be undone. It can. Medicare lets a person stop hospice at any time, for any reason, and come back later if they qualify again. Some people do both. This note explains how stopping works, what happens when someone gets better, how to change hospices, and what coverage looks like on either side.

The short answer

• A person can stop hospice at any time. Medicare calls this revoking the election.¹
• When they stop, their regular Medicare coverage comes back, including treatment to cure the illness.¹
• If they qualify again later, they can choose hospice again.¹
• A hospice can discharge someone who is no longer terminally ill, and they can come back to hospice if that changes.²
• A person can change hospices once in each benefit period without stopping hospice at all.³

Why people stop

Families stop hospice for real reasons, and none of them are wrong.

• A new treatment becomes available, and the person wants to try it.
• The person changes their mind about a treatment they’d turned down.
• They want a hospital stay for something hospice wouldn’t treat.
• They’re doing much better than anyone expected.

Hospice is built around what the person wants. If what they want changes, the plan should change with it. Tell the hospice team first. Sometimes what looks like a reason to stop can be handled within hospice, like a short inpatient stay for symptoms or a visit with the person’s own doctor. Sometimes it can’t, and stopping is the right choice.

How stopping works

Stopping is simple. The person, or their legal representative, signs a statement saying they’re revoking hospice and gives it to the hospice. The statement includes the date it takes effect, which can’t be earlier than the day it’s signed.¹

From that date, Medicare no longer covers hospice care for that person, and the Medicare coverage they gave up when they chose hospice comes back.¹ That includes treatment intended to cure the illness. Someone who kept a Medicare Advantage plan goes back to using it.

One thing to know: stopping ends the current benefit period. The days left in it are given up, and if the person comes back later, they start a new benefit period.¹

Before you stop: questions to talk through

A short conversation with the hospice team and the person’s doctor before signing makes the change smoother.

• What treatment is planned, and what does the doctor expect it to do?
• Who will manage pain and other symptoms once hospice ends?
• The hospital bed, the oxygen and the medicines came through hospice. How will they be replaced, and what will they cost under regular coverage?
• Would home health or palliative care help in the meantime?
• If things change again, who do we call to come back?

None of these questions are reasons to stay on hospice. They’re how a family makes sure nothing falls through the gap.

When someone gets better

Some people on hospice improve. Their appetite comes back, their strength returns, or the decline they were in levels off. It happens, sometimes because steady visits and good symptom care take away the crises that were wearing someone down.

When the hospice determines a person is no longer terminally ill, Medicare’s rules let the hospice discharge them.² A discharge isn’t a judgment and it isn’t a penalty. It means Medicare’s condition for hospice, a life expectancy of six months or less if the illness runs its normal course, isn’t met right now.⁵

After a discharge, the person’s regular Medicare coverage comes back, and they can choose hospice again at any time if they become eligible.² Medicare also requires a discharge plan, so the person leaves with care arranged rather than a sudden gap.² Some go from hospice to home health, or to palliative care, which can help with symptoms alongside any treatment.

Benefit periods, and why they matter

Medicare hospice runs in benefit periods: two periods of 90 days, then an unlimited number of periods of 60 days.⁴ Before each new period, the hospice physician recertifies that the person is still terminally ill.⁵

In one picture

Medicare hospice runs in benefit periods

90 days90 days60 days60 days60 days

the hospice physician recertifies

two periods of 90 days, then an unlimited number of periods of 60 days

Source · law.cornell.edu

There’s no limit on how long someone can be on hospice as long as they still qualify. A person can be on hospice for longer than six months. The six months is a doctor’s best estimate at the start, not a deadline.

Changing hospices

If a family isn’t happy with its hospice, it doesn’t have to stop hospice to change. Medicare lets a person change their hospice once in each benefit period, and doing so isn’t a revocation.³ The new hospice and the old one coordinate the transfer, and coverage continues without a gap.

Coming back

If someone stopped hospice or was discharged, and their illness progresses again, they can choose hospice again whenever they’re eligible.^1,2 A doctor certifies again that they’re terminally ill, and a new benefit period begins. Coming back happens, and it isn’t a sign that anything went wrong.

What we tell families

Choosing hospice is choosing a kind of care, not giving up the right to change your mind. At HealthView, we’d rather a family say yes to hospice when it would help, knowing they can stop, than wait until the last days because the choice felt permanent. Most of what hospice gives a family, the help with pain and breathing, the nurse who answers at 2 AM, the time back together, comes from the weeks, not the days.

Questions families ask

If my dad stops hospice, will Medicare still pay for his treatment?

Yes. Once the revocation takes effect, the Medicare coverage he gave up comes back, including treatment to cure the illness.¹

Can my mom go back on hospice after stopping?

Yes, whenever she’s eligible again.¹

What happens if hospice says my wife is doing too well?

The hospice can discharge her when she’s no longer terminally ill. She keeps her regular Medicare, and she can come back to hospice if her illness progresses.²

Does it cost anything to stop hospice?

No. There’s no fee to stop or to come back. Once hospice ends, care is covered by the person’s regular Medicare, with its usual deductibles and coinsurance.¹

Do we have to stop hospice to switch to a different hospice?

No. You can change hospices once in each benefit period without stopping hospice.³

Sources

Sources · 5 references

1. 42 CFR 418.28, “Revoking the election of hospice care.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)
2. 42 CFR 418.26, “Discharge from hospice care.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)
3. 42 CFR 418.30, “Change of the designated hospice.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)
4. 42 CFR 418.21, “Duration of hospice care coverage, election periods.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)
5. 42 CFR 418.22, “Certification of terminal illness.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)