A hospice referral begins a conversation about whether a hospice program can meet a person's needs and goals. Referral, eligibility assessment and enrollment are separate steps. Nursing care coordination should make the status of each step clear to the patient and the teams involved.
For Medicare, hospice is a Part A benefit with defined eligibility and election requirements. Other coverage arrangements should be checked with the relevant program or payer.
Explain eligibility and election accurately
CMS describes Medicare eligibility as including care through a Medicare-certified hospice and physician certification of a prognosis of six months or less if the illness follows its normal course. The patient elects the benefit through a signed statement. Hospice care follows an individualized plan developed with the interdisciplinary team and the patient or representative and caregiver.
Medicare's coverage explanation distinguishes hospice care for comfort and symptom management from treatment intended to cure the terminal illness and related conditions. Covered care for unrelated health problems can continue under the applicable Medicare benefits. Ask the hospice to explain which services and medicines belong in its plan and how other care will be coordinated.
Avoid saying that hospice means “no treatment” or that every existing medicine must stop. An individual treatment plan requires discussion with the responsible clinicians.
Do not turn six months into an expiration date
The Medicare benefit provides two ninety-day periods followed by additional sixty-day periods when eligibility continues. Recertification is required; the third benefit period and later recertifications include a face-to-face encounter by a hospice physician or nurse practitioner. A person who lives beyond six months does not automatically lose eligible hospice care.
This is a coverage framework, not a prediction of an individual's date of death.
Prepare the referral conversation
A suggested nursing handoff identifies the patient's goals, questions about hospice, current setting, relevant care needs, available support and communication preferences. Tell the receiving program whether an informational discussion, eligibility assessment or planned admission is being requested.
Invite the patient to explain what they understand about the referral. Record questions that need a hospice clinician's answer instead of presenting assumptions as agreed decisions.
For example, in a fictional referral, a patient wants information about support at home but has not elected hospice. The record should say that an informational conversation is requested. “Hospice arranged” would overstate what has happened.
Clarify the everyday arrangements
Before a transition, ask the program to explain visits, telephone support, equipment and medicine arrangements, and whom to contact when needs change. Discuss which tasks the patient or caregiver would be expected to manage and what support is actually available.
Medicare generally does not cover ordinary room and board through the hospice benefit, with exceptions for qualifying short-term inpatient or respite care arranged by the hospice. Do not let the term “hospice admission” imply a covered residential placement.
Confirm the agreed start, responsible team and remaining questions. Related pages cover palliative care referrals, caregiver readiness and family-centered communication.
Sources
- Hospice (accessed 2026-09-17) — CMS, page updated September 8, 2026.
- Hospice Care Coverage (accessed 2026-09-17) — Medicare.gov.