Your Right to Switch Hospice Providers

Can you switch hospice agencies?

Yes. Medicare's hospice benefit runs in defined benefit periods — two of ninety days, then sixty-day periods that repeat without limit — and a patient may change the designated hospice once in each of those periods 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care.. The decision belongs to the patient, or to the person authorized to speak for them. The agency being left does not have to consent. No physician has to approve the move. And if the problem is tonight rather than a pattern, the current hospice's nurse line is staffed around the clock, and that call comes first.

What makes the question hard is not the rule. It is the fear underneath it: that switching hospices means losing hospice. Families picture coverage lapsing, a prognosis argued again from the beginning, a new six-month clock. None of that happens. The election of the benefit stays live straight through the change. Only the name on the plan of care is different.

The right exists because the benefit belongs to the patient rather than to the agency delivering it. A hospice is the contractor. When the contractor is wrong, the contract is not the thing you cancel.

A transfer is not a revocation

These are two different acts, and the words get used interchangeably — sometimes by staff who should know the difference. A transfer keeps the Medicare hospice benefit running and changes which agency delivers it. A revocation ends the election itself. Medicare requires a revocation to be made in a signed written statement; a verbal revocation is not accepted, and there is no waiting period before a person may elect hospice again 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care..

That last clause is the one families never hear. Going on hospice more than once is ordinary rather than exceptional. A person can revoke, pursue a treatment, and come back. Re-electing hospice after revocation carries no waiting period, though a physician certifies the terminal prognosis again for the new benefit period 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care..

The difference, in the paperwork.

Families revoke by accident. Somebody calls the agency at two in the morning, says we're done, and means we are done with you. The safer sentence names the agency: we are changing hospices. Anything that could be read as leaving the benefit altogether is worth putting in writing, with a date, and reading back to the person who took the call.

What the change looks like on paper

One document does the work. The patient or their representative files a signed statement with both hospices — the one being left and the one being joined — naming each agency and giving the date the change takes effect 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care.. There is no application to be approved, no waiting list, no requirement to give a reason. On the effective date, the incoming hospice admits the patient and its plan of care governs.

A change of hospice is not a new election of the benefit. The certification of terminal illness already on file continues to stand, and the benefit period keeps running on its original calendar rather than resetting 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care.. That is the practical difference between transferring and revoking: one preserves the clock, the other stops it.

What the new agency does. The incoming hospice sends a nurse for an admission assessment, writes its own plan of care, assigns its own case manager, and sets up its own after-hours line. Expect the intake paperwork to be repeated in full. Expect to tell the story again, to someone who has not heard it.

What is worth asking for. Many families ask the outgoing hospice to send the clinical record straight to the incoming one — a provider-to-provider transfer rather than a folder carried across a kitchen table — and ask the incoming nurse to confirm receipt before the first visit. The medication list, the standing orders, and the resuscitation paperwork are the three things worth confirming aloud rather than assuming.

How hospice benefit periods decide your timing

One change per period is only a constraint if you know which period you are in. Hospice benefit periods run in a fixed sequence: two periods of ninety days, followed by sixty-day periods that continue for as long as the patient stays certified 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care.. Eligibility rests on a physician's judgment that the illness, running its normal course, would be expected to end life within six months 2Ref 2Centers for Medicare & Medicaid Services (2024).Medicare Hospice Benefits (CMS Product No. 02154).That hospice eligibility rests on a physician's certification of a terminal prognosis of six months or less if the illness runs its normal course..

A change used in the first ninety-day period does not consume the change available in the second. At each period boundary a hospice physician recertifies the prognosis, which means two things at once: a patient who outlives six months does not lose the benefit, and a family that has already transferred once gets the ability to transfer again 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care..

The current hospice knows where you are, and it is written on the certification — which period, and what day of it. If the one change has already been used, waiting for the next period is usually the better instrument. Revocation is heavier, it is not designed for this, and it is not a substitute for a transfer.

What carries across, and what starts again

The benefit carries. The people do not. What Medicare's hospice coverage includes — nursing, the home health aide, medications and equipment related to the terminal illness, social work, chaplaincy, and grief support for the family — is defined by the benefit rather than by the agency, so the same categories are covered the day after a transfer as the day before 3Ref 3Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.What the Medicare Part A hospice benefit covers — nursing, aide services, medications and equipment related to the terminal illness, social work, chaplaincy, and grief and bereavement support for the family — as categories defined by the benefit rather than by any particular agency.. What you are actually changing is who arrives, how quickly, and at what hour of the night.

Medicare pays a hospice a daily rate for each enrolled patient 4Ref 4Centers for Medicare & Medicaid Services (2024).Hospice (Fee-for-Service Providers).That Medicare pays a hospice under a per-diem payment structure for each day a certified beneficiary is enrolled.. That per-diem is why each agency supplies drugs and equipment through its own pharmacy and its own contracts rather than inheriting another agency's: on the effective date the money moves, and the supply chain moves with it. A hospital bed gets re-delivered. An oxygen concentrator gets swapped. The comfort medications in the refrigerator were dispensed under the outgoing hospice's orders, and the incoming hospice writes its own.

The question worth asking before the effective date: how the first twenty-four hours of medication and equipment will be covered, and who is on call that night. A well-run transfer answers it before anyone has to ask.

Grief and bereavement support for the family is also part of what the hospice benefit covers 3Ref 3Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.What the Medicare Part A hospice benefit covers — nursing, aide services, medications and equipment related to the terminal illness, social work, chaplaincy, and grief and bereavement support for the family — as categories defined by the benefit rather than by any particular agency.. It is worth asking the incoming agency how its bereavement program actually runs, because the hospice bereavement benefit is the piece of hospice a family uses after the person has died — and it is the piece nobody thinks to ask about while the person is still alive.

Choosing the hospice you move to

A transfer is worth its disruption only if the next agency is better, and better can be checked before anything is signed. Medicare publishes quality measures and family-experience survey results for every certified hospice through its Care Compare tool, which means two agencies can be compared on the public record instead of on a brochure 5Ref 5Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).That quality measures and family-experience survey results for Medicare-certified hospices are publicly reported and can be compared by consumers through the official Care Compare tool.. Choosing your own hospice is the patient's right at the first election and at every change after it.

Who actually picks the hospice, in practice, is often a discharge planner with one name on a list and an afternoon to fill a bed. That name is a suggestion. It carries no obligation, and it never did.

The reasons families leave are usually concrete, and the same specifics make good admission questions for the next agency. Visits that were promised and did not happen. A nurse line that rang out at midnight. Pain that stayed uncontrolled across a week while everyone waited for a call back. If those are the signs to switch hospices, they are also the questions to put to whoever comes next: how fast a nurse reaches a home after an after-hours call, how often a nurse visits in the last days of life, and what the agency does when symptoms cannot be managed where the patient lives.

When a transfer is the wrong tool

Not tonight. A transfer has an effective date, an admission visit, and a handoff, and the hours inside that handoff are hours when no one's nurse is formally assigned. When the problem is a symptom happening right now — pain that will not settle, breathing that has audibly changed, restlessness in the last days — the faster instrument is the current hospice's nurse line, which is staffed twenty-four hours a day, including the night you assume nobody will answer.

Medicare's hospice benefit also includes higher levels of care for symptoms that cannot be controlled where the patient lives 1Ref 1Centers for Medicare & Medicaid Services (2024).Medicare Benefit Policy Manual, Chapter 9 - Coverage of Hospice Services Under Hospital Insurance.The benefit-period structure (two 90-day periods, then unlimited 60-day periods) that determines when a change of designated hospice may be made; the written-statement mechanics of electing, changing, and revoking hospice, including that a verbal revocation is not accepted and that there is no waiting period before re-electing; recertification at each period boundary; and the existence of higher levels of hospice care.. An agency that has never mentioned them, or that raises them only under pressure, is telling you something worth hearing. The sequence most families find workable is the on-call nurse tonight, the clinical manager in the morning, and a levels-of-care conversation the same day.

Then, if the pattern repeats rather than resolves, make the change in daylight, with an effective date that everyone involved has written down.