You are not choosing to give up. You are choosing to ask, “What would make the days easier?” Hospice is the care that lets comfort lead. For many families in Orange County, the next question is how to manage the costs. Medicare is designed to ease that burden. When you qualify and elect hospice, Medicare Part A covers the core services that bring comfort home.
In the sections that follow, you will see who qualifies for Medicare-covered hospice, what is included, and how to begin hospice care in Orange County.
Hospice Eligibility: Do You Qualify for Medicare-Covered Hospice?
You qualify for the Medicare hospice benefit if all of the following are true:
- You have Medicare Part A.
- Your regular doctor, if you have one, and the hospice doctor certify that you have a life expectancy of six months or less if the illness runs its normal course.
- You choose comfort-focused care instead of treatments that aim to cure the hospice illness.
- You sign a statement electing hospice for your hospice illness and related conditions.
If you qualify, Medicare Part A provides two 90-day benefit periods followed by an unlimited number of 60-day periods as long as the hospice doctor recertifies that you still meet criteria. A face-to-face visit with a hospice physician or nurse practitioner is required before day 180 and each 60-day recertification after that.
What Medicare Covers in Hospice
Once you elect hospice, Medicare Part A covers nearly everything related to the hospice illness and related conditions, including:
- Visits from your hospice nurse, aide, social worker, chaplain, and physician
- Medications for symptom control and pain relief
- Durable medical equipment such as a hospital bed, oxygen, wheelchair, commode
- Bandages and supplies for wound and symptom care
- Short-term inpatient care when symptoms cannot be managed at home
- Respite care to give family caregivers a needed break
- Bereavement support for the family
- Incontinent supplies
You pay no charge for hospice care from a Medicare-approved provider. You may have a small copay for some outpatient medications and 5% of Medicare’s approved amount for inpatient respite care. Room and board in a facility are not covered unless the hospice team arranges a covered inpatient stay for symptom control.
If you have conditions unrelated to your hospice illness, Medicare will continue to cover those services as usual.
How This Works in Orange County
Most Orange County seniors are enrolled in Original Medicare or a Medicare Advantage plan. No matter which you have, the hospice benefit is standardized by Medicare.
- If you are in a Medicare Advantage plan, Original Medicare covers hospice services once you elect hospice. Your Advantage plan may continue to cover unrelated services and extras like vision or dental if your plan includes them. Your plan must help you find a Medicare-approved hospice.
- If you also have Medi-Cal through CalOptima Health, hospice is covered for eligible members when a physician certifies a six-month prognosis. Many Orange County residents have both Medicare and Medi-Cal.
Common Eligibility Questions, Answered
- Do I need to stop all treatments?
You choose care that focuses on comfort rather than cure for the hospice illness. You can still receive treatments that manage symptoms and improve quality of life. You can also keep getting treatment for unrelated conditions. - What if I live longer than six months?
You can continue hospice as long as the hospice physician recertifies that you remain eligible. Benefits continue in 60-day blocks, without a hard time limit. A face-to-face check by a hospice physician or nurse practitioner is required starting at day 180 and each 60-day period after. - Can I change hospice providers?
Yes. You have the right to change hospice providers once during each benefit period if you choose. - Who decides if I qualify?
Your attending doctor, if you have one, and the hospice medical director certify your prognosis. CMS defines hospice illness as a life expectancy of six months or less if the illness runs its normal course. Local Coverage Determinations give clinical guidance to support this decision.
How to Start Medicare Hospice in Orange County
- Talk with your doctor.
Ask whether your condition is likely to meet the six-month prognosis and whether a comfort-focused plan fits your goals. - Choose a Medicare-approved hospice.
You can compare Medicare-certified hospices that serve your ZIP code on Care Compare. Focus on responsiveness, home visit frequency, 24/7 support, and patient experience. - Complete the election paperwork.
You will sign forms choosing hospice for your hospice illness and acknowledging that the focus is comfort. Your hospice team obtains physician certifications and schedules your first visit. Timing rules allow certifications shortly before admission, and face-to-face rules apply starting at day 180. - Receive your plan of care and covered services.
Your hospice team coordinates medications, equipment, and visits, and supports your caregivers. You pay no charge for covered services, with small copays in limited cases.
Documents And Information That Help Your Hospice Start Smoothly
Having these ready can speed admission and reduce stress:
- Medicare card and any Medi-Cal/CalOptima or supplemental plan information
- List of current medications and allergies
- Names and numbers of your specialists and preferred pharmacy
- Recent hospital or clinic notes and any advance directives
- Contact information for the primary caregiver
Your hospice team can help gather records and coordinate with your doctors.
How Maxcare Hospice Supports Orange County Families
When you call Maxcare, you speak with an intake nurse who listens first. If hospice is right, we coordinate with your doctor, complete needed certifications, and start services quickly. Your plan can include:
- Routine Home Care, Continuous Home Care, General Inpatient Care, and Respite Care
- Physical, emotional, and spiritual support, plus bereavement care for family
- Wound care, therapeutic music, veterans support, volunteer companionship, and help with IHSS applications
- Multicultural care with language support across Orange County, Los Angeles County, and the Inland Empire
Talk to Our Hospice Care Team Today
Call (714) 844-7777 or message us to ask about Medicare hospice eligibility and next steps. Maxcare Hospice serves families across Orange County, Los Angeles County, and the Inland Empire, and we will guide you with compassion and full expertise.
