If you’re researching hospice care for a parent or spouse, cost is probably one of the first worries on your mind. Here’s the short answer: for most Georgia families, Medicare covers the full range of hospice services related to a terminal illness, with very little out-of-pocket cost. 

This guide walks through exactly what’s included, what isn’t, and how the benefit works so you can move forward with clarity instead of guesswork.

Does Medicare Cover Hospice Care in Georgia?

Yes. Hospice is a covered benefit under Medicare Part A for anyone enrolled in Original Medicare, regardless of which Georgia county you live in. To use it, your loved one’s care must come from a Medicare-certified hospice provider like Golden Rule Hospice, and a physician must certify a terminal illness with a prognosis of six months or less, if the illness runs its expected course.

That six-month estimate is a clinical judgment, not a deadline. Coverage continues in renewable benefit periods as long as your loved one continues to meet eligibility criteria, so there’s no fixed cutoff to plan around.

How Your Loved One Becomes Eligible

Three things need to be true before Medicare hospice coverage begins:

1. Medicare Part A enrollment. Your loved one must already have Part A coverage in place.
2. Physician certification. Both the hospice medical director and your loved one’s regular attending physician (if they have one) must certify, in writing, that the illness is terminal with a life expectancy of six months or less if it runs its normal course.
3. A signed election statement. Your loved one, or their authorized representative, formally elects the hospice benefit with a Medicare-certified hospice provider. This is the point where curative treatment for the terminal illness stops, and comfort-focused care begins.

This last step is worth pausing on, because families sometimes worry that electing hospice is irreversible. It isn’t. Your loved one can revoke hospice at any time and return to standard Medicare coverage, including curative treatment, if their situation changes. If they later decide hospice is right again, they can re-elect the benefit without penalty.

How Benefit Periods Work

Medicare structures hospice coverage into benefit periods rather than one continuous stretch:

• Two 90-day periods to start.
• Unlimited 60-day periods after that, for as long as your loved one continues to meet the terminal prognosis criteria.

At the start of each period, the hospice team reassesses eligibility. After the initial 180 days, Medicare requires a face-to-face visit between your loved one and a hospice physician or nurse practitioner to recertify continued eligibility. This isn’t a hurdle designed to end care early. It’s a built-in check to make sure the plan of care still matches what your loved one needs, and in most cases it happens quietly as part of routine visits, without disrupting the rhythm of care your family has already settled into.

What Medicare Covers Under the Hospice Benefit

Once your loved one elects hospice, Medicare covers nearly everything related to the terminal diagnosis, including:

• Physician and nursing care – visits from the hospice medical director and regular nursing visits to manage symptoms and coordinate care
• Medical equipment and supplies – hospital beds, wheelchairs, and other equipment needed for comfort at home
• Prescription medications for pain and symptom management related to the terminal illness
• Home health aide and homemaker services for personal care support
• Family and caregiver support, including counseling and guidance for the people caring for your loved one
• Physical support and symptom management to keep your loved one as comfortable as possible
• Spiritual and grief support, both during care and through bereavement
• Short-term inpatient and respite care, when symptoms need more intensive management or a caregiver needs rest

There is no deductible for hospice care under Medicare Part A. Coverage applies wherever your loved one calls home, whether that’s their own house, a family member’s home, or a nursing facility. To see how these services are organized day to day, our Levels of Care page breaks down what routine, continuous, and respite care actually look like.

What Medicare Does Not Cover

A few costs fall outside the hospice benefit, and it helps to know about them ahead of time rather than being surprised later:

• Room and board at a nursing home or assisted living facility. Medicare covers the hospice services delivered there, but not the cost of the room itself. In Georgia, Medicaid may help cover room and board for patients who meet state eligibility requirements.
• A small prescription copay, up to $5 per prescription, for outpatient drugs related to pain and symptom control.
• A respite care copay, roughly 5% of the Medicare-approved amount, capped at the annual inpatient hospital deductible.
• Treatment intended to cure the terminal illness. Once your loved one elects hospice, the focus shifts to comfort rather than curative treatment for that specific condition. Care for unrelated health issues is still covered under Original Medicare as usual.

What If My Loved One Has a Medicare Advantage Plan?

Georgia families enrolled in a Medicare Advantage plan (an HMO or PPO through a private insurer) don’t lose hospice coverage. When your loved one elects hospice, Original Medicare takes over payment for hospice-related care and for any Medicare-covered services tied to the terminal illness, even if they were previously in a Medicare Advantage plan. Extra benefits your plan offers, like dental or vision coverage, continue as long as premiums are paid. Any care unrelated to the hospice diagnosis can still be managed through either Original Medicare or the Advantage plan.

What If Medicare Isn’t Enough?

Most patients who need hospice care are covered through Medicare or Medicaid, but every family’s situation is different. If there are gaps in coverage, private insurance, VA benefits, or charitable support may help fill in the difference. Our Who Pays for Hospice page walks through these options in more detail, and no family should feel that cost stands between their loved one and the care they need.

The Four Levels of Care Medicare Recognizes

Medicare’s hospice benefit isn’t one-size-fits-all. It’s organized into four levels of care, and your loved one may move between them as their needs change:

• Routine home care. The most common level. A nurse visits several times a week, and the hospice team is reachable by phone around the clock, but there isn’t continuous overnight staffing in the home.
• Continuous home care. Used during a medical crisis, such as severe pain or breathing distress, when a patient needs intensive nursing or aide support for at least eight hours within 24 hours. This level is temporary and tied to the crisis itself.
• General inpatient care. For symptoms that can’t be managed comfortably at home and require short-term care in a hospital, hospice facility, or skilled nursing facility.
• Respite care. Short-term inpatient care, typically up to five days, so a family caregiver can rest. This is the one level where a small copay, roughly 5% of the Medicare-approved cost, applies.

Our Levels of Care page goes into more depth on how the team decides which level fits your loved one at any given time.

Frequently Asked Questions

• Does Medicare cover hospice care in a nursing home? Yes, Medicare covers the hospice services themselves regardless of setting. It does not cover the room and board charged by the nursing facility, which is billed separately and may be covered by Medicaid for patients who meet Georgia’s eligibility requirements.
• Will my loved one lose coverage for unrelated health conditions? No. Original Medicare continues to cover treatment for health issues that aren’t related to the terminal diagnosis, subject to normal deductibles and coinsurance.
• Can we switch hospice providers if we’re not satisfied? Yes, though Medicare generally expects care to come from one hospice provider at a time. If you’d like to change providers, talk with your current hospice team about the transition process.
• Is there a limit to how long Medicare will cover hospice? No fixed limit exists as long as your loved one continues to meet the terminal prognosis criteria at each recertification.

We’re Here to Help You Understand Your Options

Figuring out what Medicare covers shouldn’t add to an already heavy load. Golden Rule Hospice serves families across Fulton, Cobb, Gwinnett, DeKalb, and other counties throughout the Atlanta and Alpharetta area, and our team can walk through your loved one’s specific coverage with you, answer your questions, and help build a plan that fits your family. Reach out today to talk with someone who can help.