If you or your loved one live in Orange County and are considering hospice, here is the quick truth. To qualify under Medicare Part A, a hospice physician and your doctor certify a life expectancy of six months or less if the illness runs its normal course, you choose comfort-focused care rather than curative treatment for the terminal illness, and you sign a statement electing hospice. Most families pay $0 for covered hospice services, with small copays possible for certain outpatient medicines and short-term respite care.
This guide walks you through eligibility, how to elect the benefit, what recertification involves, what costs to expect, and how hospice services work in Orange County so you can plan with peace of mind.
Who Qualifies For The Medicare Hospice Benefit
You qualify if you have Medicare Part A and meet all of the following:
- Terminal prognosis: Your hospice doctor and your regular doctor certify that life expectancy is six months or less if the illness runs its normal course.
- Care focus: You accept comfort care rather than treatment intended to cure the terminal illness and related conditions.
- Election of hospice: You sign a statement choosing hospice in place of Medicare-covered treatments for the terminal illness and related conditions.
Under federal rules, electing hospice waives payment for curative services related to the terminal illness from non-designated providers during the election period. Care for unrelated conditions remains covered by Medicare as usual.
How Benefit Periods And Recertification Work
Medicare structures hospice coverage in timed periods:
- First 90 days
- Second 90 days
- Unlimited 60-day periods after that, as long as you remain eligible.
Face-to-face requirement – Beginning with the third benefit period (day 180) and at each subsequent recertification, a hospice physician or hospice nurse practitioner must complete a face-to-face encounter within the 30 days before the new period starts. Their clinical findings support the recertification that life expectancy remains six months or less.
Certification timing – The hospice must obtain physician certification by the end of day 3 of each benefit period. Initial certifications and recertifications can be completed up to 15 days before the next period begins.
If you stabilize or improve – You may be discharged alive if you no longer meet eligibility. You can return to hospice later if you again qualify. This is common and it is allowed.
What You Pay Under Medicare
Most families pay nothing for covered hospice services from a Medicare-approved hospice. There are a few exceptions:
- Outpatient medications for symptom control and pain relief may have a copay up to $5 per prescription.
- Inpatient respite care may have 5% coinsurance, not exceeding the yearly inpatient hospital deductible.
- Room and board at residential settings is generally not covered, unless you are receiving general inpatient or respite care arranged by your hospice.
- Care for unrelated conditions continues under Medicare, with any normal deductibles and coinsurance.
What Is Covered Vs. Not Covered
Covered when related to the terminal illness and arranged by your hospice:
- Visits from nurses, physicians, aides, social workers, and chaplains
- Pain and symptom management, medical equipment, and supplies
- Short-term inpatient care for symptom crises
- Respite care for caregivers, up to 5 days at a time, when arranged by your hospice
- Grief and bereavement support for your family
Not covered once you elect hospice:
- Treatments intended to cure your terminal illness and related conditions
- Prescription drugs aimed at cure rather than symptom relief
- Room and board in a facility, except when Medicare covers an arranged inpatient level of care
- Care from other hospices that is not arranged by your elected hospice
Step-By-Step: How To Elect The Hospice Benefit
- Talk with your doctor and the hospice: Confirm that the medical criteria are met and discuss your goals.
- Review and sign the hospice election statement: This names the hospice, confirms you understand hospice is palliative rather than curative, and explains what Medicare services you waive during the election period.
- Create your plan of care: You, your family, and the hospice team set goals and visit schedules.
- Start services: Equipment and medications related to the terminal illness are delivered or arranged by the hospice.
- Know your rights: You may change hospice providers once per benefit period. You can also revoke hospice if you decide to pursue curative treatment, and you may re-elect later if you qualify again.
Recertification Checkpoints At A Glance
- Days 1-90: Initial period with certification on file.
- Days 91-180: Second 90-day period with recertification.
- Day 180 and beyond: Each 60-day period requires recertification plus a face-to-face clinical visit within the 30 days before the period starts.
Tip for caregivers: Put the next recertification date on your calendar and ask your nurse to confirm when the face-to-face is scheduled. That keeps the benefit continuous without gaps.
What To Expect From Your Hospice Team In Orange County
- A plan that matches your goals: Comfort, safety, and dignity at home, in assisted living, or in a nursing facility.
- 24/7 phone support: Nurses guide you through nighttime changes to help avoid unnecessary ER visits.
- Rapid response for symptom spikes: Visits increase when you need more help.
- Caregiver support: Education, hands-on teaching, and short-term respite options that we can help arrange.
If you are new to the idea of taking a break, read our practical micro-respite tips and learn how to qualify for respite care so you can step away with confidence.
FAQs
Can I keep my primary doctor involved?
Yes. You can designate an attending physician who continues to guide your care along with the hospice.
What if I am in a Medicare Advantage plan?
Your plan helps you locate a Medicare-approved hospice. Once you elect hospice, Original Medicare covers services related to the terminal illness, and your plan can still cover unrelated services and extras if you keep paying premiums.
Can I continue medications that feel curative?
Medications for symptom control and quality of life may be covered. Drugs intended to cure the terminal illness are not covered under the hospice election. Ask your nurse or doctor to review each medication with you.
What happens if I live longer than six months?
You can remain on hospice as long as you continue to meet eligibility at each recertification. There is no hard stop.
What if my condition improves?
If you no longer meet eligibility, you may be discharged from hospice. You can return later if you again qualify.
A Quick Checklist Before You Elect Hospice
- Ask your doctor if the six-month prognosis standard applies in your case.
- Confirm the hospice is Medicare-certified and serves your city in Orange County.
- Review the election statement and what you are waiving.
- Clarify your likely out-of-pocket costs for outpatient meds and possible respite copays.
- Put the recertification window and the face-to-face date on your calendar.
Next Steps For Orange County Families
- If you are in Anaheim, Santa Ana, Irvine, Huntington Beach, or nearby cities, call the Orange Hospice team to review eligibility and start your plan of care. We coordinate with your physicians, arrange equipment and supplies, and teach you what to expect in the first week.
- If you care for someone at home and need breaks, ask about inpatient respite or volunteer options. We will help you understand copays and availability.
Learn Medicare Hospice Eligibility in Orange County: Call Us
Have questions about how to qualify for the Medicare hospice benefit, recertification, or what to expect? Call (714) 790-0594 or visit our contact page. Our team explains eligibility, timelines, and services for families in Orange County and Anaheim, and helps you take the next step with assurance.
