Going on Hospice More Than Once

Can you go on hospice more than once?

Yes. Medicare's hospice benefit can be used more than once, and there is no cap on the number of times. A person can leave hospice and return to it later — this is a normal, expected part of how the benefit works 1Ref 1National Institute on Aging (NIH) (2024).Frequently Asked Questions About Hospice Care.NIA consumer FAQ stating that patients can leave hospice and return to it later.. There are two ways someone leaves: they choose to stop it, or the hospice discharges them because they no longer meet the eligibility rules. Either way, re-enrolling later is allowed.

This surprises many families, because the word 'hospice' can sound permanent. It is not. Changing your mind on hospice is a recognized right, and re-electing hospice later does not count against you or use up a limited allowance. The benefit was designed for illnesses that rise and fall.

Leaving hospice on purpose — and coming back

One way to leave is to revoke the benefit — a deliberate choice to stop hospice, usually to pursue treatment aimed at the illness again. Revoking hospice has to be done in writing; a verbal statement is not enough, so the hospice provides a revocation statement to sign and date 2Ref 2Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.CMS policy manual: revocation of hospice must be in writing (a verbal statement is not accepted), re-election starts a new benefit period, and there is no waiting period to re-elect.. Re-electing hospice starts a new benefit period, and there is no waiting period before returning 2Ref 2Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.CMS policy manual: revocation of hospice must be in writing (a verbal statement is not accepted), re-election starts a new benefit period, and there is no waiting period to re-elect..

People revoke for real reasons: a new treatment they want to try, a clinical trial, or simply a change of heart. Leaving hospice and coming back later is common, and the door genuinely reopens. What revoking does end is the current benefit period, so a fresh certification of eligibility comes with returning — the team handles this, but it is worth knowing it is a real step, not automatic.

Being discharged alive — and re-enrolling

The other way to leave is a live discharge: the hospice discharges a person who is still alive, most often because they have stabilized or improved and no longer have a life expectancy of six months or less. It can also happen if someone moves out of the hospice's service area. This is not a punishment, and it does not bar returning — if the illness worsens again, the person can re-enroll 1Ref 1National Institute on Aging (NIH) (2024).Frequently Asked Questions About Hospice Care.NIA consumer FAQ stating that patients can leave hospice and return to it later..

Live discharge is worth understanding because it varies by hospice. Research on people discharged alive found that burdensome transitions afterward — a hospitalization, a readmission, or dying in the hospital — are more common with for-profit hospices and after very short stays 3Ref 3Peer-reviewed cohort study (see article) (2024).Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.Cohort of Medicare beneficiaries discharged alive from hospice: burdensome transitions such as hospitalization, readmission, or hospital death are more common with for-profit hospices and after short stays.. Earlier analysis likewise found problematic live-discharge patterns concentrated at for-profit agencies rather than not-for-profit ones 4Ref 4Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.Analysis showing problematic (burdensome) live-discharge patterns are far more common at for-profit than not-for-profit hospices — a signal to weigh when selecting an agency.. A high live-discharge rate can be a signal worth checking when you pick an agency.

How the benefit periods work

Hospice runs in benefit periods: two 90-day periods, followed by an unlimited number of 60-day periods 5Ref 5Centers for Medicare & Medicaid Services (2024).Medicare Hospice Benefits (CMS Product No. 02154).Official consumer booklet: the benefit is two 90-day periods then unlimited 60-day periods, and eligibility requires a terminal prognosis of six months or less if the illness runs its normal course.. Before each new period, a hospice doctor must recertify that the person still has a life expectancy of about six months or less if the illness runs its usual course. Because the later periods are unlimited, there is no ceiling on how long someone can stay — or on how many periods they use across separate enrollments.

This is the answer to a common fear about hospice after six months: the six-month prognosis is not a deadline, and it does not remove anyone on a schedule. As long as a person keeps meeting eligibility at recertification, hospice simply continues — these unlimited benefit periods and recertification are what let care outlast the original estimate. Seeing how Medicare hospice benefit periods work makes re-enrolling far less mysterious.

Is there a limit on how many times?

No. There is no lifetime limit on electing hospice and no maximum number of times a person can go on and off. What matters each time is eligibility: to enroll, a person must be certified as terminally ill, with a life expectancy of six months or less if the illness follows its normal course 5Ref 5Centers for Medicare & Medicaid Services (2024).Medicare Hospice Benefits (CMS Product No. 02154).Official consumer booklet: the benefit is two 90-day periods then unlimited 60-day periods, and eligibility requires a terminal prognosis of six months or less if the illness runs its normal course.. Meet that, and hospice is available again, whether it is the first election or the fourth.

This flexibility exists because illness is unpredictable. Someone may enroll, rally on comfort care, be discharged, decline months later, and enroll again. Each of those turns is normal. The only real constraint is the honest clinical judgment, at each election and each recertification, that the prognosis fits.

Choosing a hospice the next time

Re-enrolling is also a chance to choose differently. A person is not bound to the hospice they used before; they can pick a new one, and they can switch hospices even mid-enrollment if theirs is not working. When comparing agencies, Medicare's CAHPS Hospice Survey reports how bereaved families rated each hospice on communication, symptom help, and whether they would recommend it 6Ref 6Centers for Medicare & Medicaid Services (2024).CAHPS Hospice Survey.Describes the CAHPS Hospice Survey, which samples bereaved primary caregivers and measures domains including communication, help for symptoms, overall rating, and willingness to recommend..

Two other signals are worth weighing, especially if a prior hospice discharged the person: the agency's live-discharge rate and whether it is for-profit or not-for-profit, since problematic live discharges cluster at for-profit agencies 4Ref 4Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.Analysis showing problematic (burdensome) live-discharge patterns are far more common at for-profit than not-for-profit hospices — a signal to weigh when selecting an agency.. Your right to switch hospice providers is part of the Medicare benefit, so if the first fit was wrong, the next enrollment does not have to repeat it.

What re-enrolling actually involves

Coming back to hospice is straightforward, but it is not instant. Because the prior benefit period ended when the person left, returning means a new election: a hospice doctor certifies the terminal prognosis again, the person or their representative signs the election paperwork, and a new benefit period begins. There is no waiting period, so this can happen quickly, but it is a real set of steps rather than simply flipping a switch. In practice, a call to a hospice starts it — the agency arranges the certification and the paperwork, often within a day or two, and care resumes. If the person is choosing a different hospice than before, that is the moment to compare, because the new team will do its own assessment and build a fresh plan of care. Nothing about having been on hospice before makes returning harder; if anything, families often know better what to ask the second time.