Levels of Hospice Care as Defined by Medicare

Hospice care focuses on treating symptoms rather than curing disease. It's an option once doctors decide someone is unlikely to live more than six months.

Hospice is also called "comfort care." It aims to relieve pain and keep people comfortable so they can enjoy a good quality of life as long as possible.

Medicare defines four levels of hospice care. Every Medicare-certified hospice provider must offer all four levels of care.

If you have Medicare Part A and Part B, you don't pay anything for hospice. But you may need to pay your share of the costs for services that are not related to your main illness. If you have a Medicare Part C plan (also known as Medicare Advantage), hospice will still be covered.

One person may need all four levels in a short period of time. Another person may need just one level of care the whole time they're in hospice.

Each level of care meets specific needs. And every person in hospice is unique.

This article describes what services are provided at each level. It also explains how a hospice team chooses the level of care that's best for the person being treated.

Level 1: Routine Home Care

Routine home care is a range of services you receive where you live. This care is for times when you are not in a medical crisis.

Members of your hospice care team will visit you at home. But they can also visit you in a skilled nursing facility, an assisted living facility, or any other place you live. They will bring the services you need to you.

Routine home care services can include:

  • Services of a doctor, physician's assistant, or nurse practitioner
  • Nursing services
  • Hospice aide services
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Social services
  • Medications for pain and other symptoms
  • Nutrition counseling
  • Spiritual support
  • Medical supplies
  • Durable medical equipment

Level 2: Continuous Home Care

Continuous home care is for times of crisis when you need a higher level of nursing care. These services may make it easier for you to stay in your home even when your symptoms get more severe.

Continuous home care means you need a nurse for at least eight hours in a 24-hour period. You may also be receiving help from other hospice team members at the same time, but at least half the care must be supplied by a nurse.

What Kind of Symptoms Qualify?

You might need continuous care if you have:

  • Pain that isn't going away
  • Severe nausea and vomiting
  • Severe breathing problems
  • Anxiety or panic attacks
  • A breakdown in your family or caregiver support system

Level 3: General Inpatient Care

There may be times when you have short-term symptoms so severe they can't be treated at home. You may need an inpatient facility.

hospice nurse helping male patient in bed

Andersen Ross / DigitalVision / Getty Images

With inpatient care, nurses can give you medication, treatments, and support around the clock.

Where Can Level 3 Care Happen?

You can receive inpatient hospice services at:

  • A free-standing hospice facility
  • A hospice unit in a hospital
  • A hospice unit in a skilled nursing facility or nursing home

Level 4: Respite Care

In some families, most of the care for a person in hospice is provided by family members. Caring for someone in hospice can be stressful. To help lower caregiver stress, Medicare allows you to have a short stay in the hospital or other facility to give your caregivers a needed break.

Respite care services are more for the family than for the person in hospice. If someone does not qualify for continuous or inpatient care but the family is having a hard time, respite care may be an option.

There is a five-day limit on respite care. Once that period is over, the patient returns home.

Who Decides the Level of Care?

To qualify for hospice care, your doctor must state that you are not likely to recover from an illness and that you are not expected to live longer than six months.

To qualify for continuous care or a higher level of care, a hospice doctor must state that the new level of care is necessary.

Summary

When a doctor certifies that someone is not expected to live longer than six months, Medicare offers hospice care. Hospice focuses on treating symptoms, not curing an illness.

Medicare has defined four levels of care to be sure everyone's needs are met.

  • Routine care provides pain relief and other treatments and therapies where you live.
  • Continuous home care provides more intensive nursing care in your home in times of crisis.
  • Inpatient care allows you to go to a hospital or other inpatient facility if you need round-the-clock care to treat severe symptoms.
  • Respite care allows you to be treated in an inpatient facility for a few days to give your caregivers a chance to rest.

Your doctor and the other members of your hospice team work together to decide which level of care you need.

Frequently Asked Questions

  • Does private insurance cover hospice care?

    Most do, because hospice care is sometimes less costly than treatment in a hospital. If your policy includes hospice care, it will probably cover most of the cost.

  • Is palliative care the same as hospice care?

    No. Palliative care focuses on caring for someone as they receive treatment that could cure them or save their life. It also supports their loved ones and caregivers. If it becomes clear that someone will not survive, care switches from palliative to hospice.

  • How do I find a hospice provider for a loved one who is dying?

    You can find a state-by-state directory of hospice organizations on the Hospice Foundation of America website. Medicare also has a helpful tool, Care Compare, where you can search for hospice and other providers.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harris PS, Stalam T, Ache KA, et al. Can hospices predict which patients will die within six months? J Palliat Med. 2014;17(8):894-8. doi:10.1089/jpm.2013.0631

  2. Samaritan Healthcare & Hospice. What are the four levels of hospice care?

  3. Centers for Medicare and Medicaid Services. Hospice. Updated August 17, 2021.

  4. CMS. Chapter 9: Coverage of Hospice Services Under Hospital Insurance: Medicare Benefit Policy Manual. November 6, 2020.

  5. Medicare. How hospice works. Updated October 3, 2021.

  6. Hospice Foundation of America. Paying for hospice care. Updated October 3, 2021.

  7. National Institute on Aging. What are palliative care and hospice care? Updated May 14, 2021.