Revoking a Hospice Election: How to Stop Hospice, Return to Regular Medicare, or Change Hospices

Many families fear one thing at the start. They think a hospice choice is final. It is not. The rules give you a way out. You can stop hospice and go back to regular Medicare. You can change to a new hospice and keep the benefit. You can also choose hospice again at a later date. Each route has its own steps. Each route needs a signed form. This guide walks through all three routes in plain steps. Our Hospice section holds more guides on care at the end of life.

What you signed at the start

Hospice is for a person whose doctor expects a life span of 6 months or less if the illness runs its normal course (Ledger B1). When you elect hospice, you choose hospice care for that illness. You also give up regular Medicare cover for care to cure that illness for that period.

That choice is made in writing. Our guide on the hospice election statement and addendum shows what you sign and what the addendum lists. Read it if you want to see your own forms with fresh eyes.

The key point for this guide is simple. A form starts the election. A form can also end it or move it. The rules do not lock you in for life. They set a clear way to change your mind.

The three routes at a glance

There are three distinct routes. They do very different things, so pick with care.

The first route is to revoke. You stop hospice. You go back to regular Medicare. The hospice benefit ends for the rest of that period.

The second route is to change hospices. You stay on the hospice benefit. Care moves from one hospice to a new one. There is no break in the benefit from the change itself.

The third route comes later. After a revocation, you may elect hospice again. That new choice can be for any other election period still open to you.

Do not mix up route one and route two. A change is not a revocation. The rule says so in plain terms. If you want to keep hospice but want a new team, ask for a change, not a revocation.

Route one: revoke and return to regular Medicare

A person may revoke a hospice election at any time during an election period. Your rep can do it for you if you cannot act on your own. The right does not end after a set number of days.

To revoke, you file a statement with the hospice that gives your care now. That statement has two parts. First, it must hold a signed statement that you revoke the election for Medicare cover of hospice care for the rest of that election period. Second, it must give the date the revocation is to take effect.

That date rule matters. The date cannot be earlier than the date the revocation is made. You cannot backdate the end. If you sign on a Tuesday, the earliest end date is that Tuesday.

Keep a copy of what you file. Ask for the date and time the hospice got it. Those facts may matter if a bill comes later for care near the change date.

What ends and what comes back when you revoke

On revocation, you are no longer covered under Medicare for hospice care in that period. That is the end you asked for. Hospice visits, hospice drugs for pain, and the rest of the hospice plan stop under the benefit.

At the same time, a door opens back up. You resume Medicare cover of the benefits you gave up when you elected hospice. Regular Medicare rules apply again to that care. You may seek the kind of care hospice had set aside, such as care aimed at a cure, under regular Medicare rules.

There is a cost to this choice. You give up the rest of that election period. The days left in that period do not wait for you. If you want hospice again, the new election falls in a later period that is still open to you.

The hospice has a task too. When an election ends by revocation, the hospice must file a notice of termination or revocation with its Medicare contractor. It must do so within 5 calendar days after the effective date, unless it has already filed a final claim.

Route two: change to a new hospice

You may change your designated hospice once in each election period. A change is not a revocation. The benefit goes on. There is no need to stop hospice to switch teams.

To change, you or your rep file a statement with both hospices. That means one goes to the hospice you have been getting care from. One goes to the new hospice. The statement must name both hospices. It must also give the effective date of the change.

Why do families change? A move to a new town is one cause. A poor fit with the team is another cause. A need the first hospice cannot meet can also lead to a change. Our guide on questions families ask on a first hospice call can help you test a new hospice before you move.

Plan the handoff with both teams. Ask who will visit on the change date. Ask how drugs and gear will move. A short call to each hospice can stop a gap in care on that day.

Route three: elect hospice again later

A revocation does not bar you from hospice for life. You may at any time elect hospice again for any other election period still open to you.

That means the facts must still fit. The person must still meet the hospice rules for that later period. Hospice is still for a person with a life span of 6 months or less if the illness runs its normal course (Ledger B1).

Some people revoke to try a new treatment. Some revoke when their health gets better for a time. If health falls again, a new election can be made. Talk to your doctor about the facts of your case at that time. Do not assume a past revocation helps or harms a new choice. Each election rests on the facts at the time it is made.

A spoken wish alone is not the filing

This point trips up many families. A person may say they want to stop hospice. That spoken wish shows intent. By itself, it is not the filing the rule asks for.

The rule asks for a statement filed with the hospice. It must be signed. It must state the revocation. It must give the effective date. Till that form is filed, the election stands as it was.

So act on a spoken wish fast and in writing. Sit down with the hospice staff. Put the wish on the right form. Sign it. Set the date. Keep your copy. The same care applies to a change of hospice. The statements must go to both hospices, in writing.

If a loved one cannot sign, a rep may act. Ask the hospice who can act as rep in your case and what proof they need to see.

Read before you sign, and sign only what you asked for

The rule lists what a revocation statement must hold. It does not list a reason. You do not have to give a reason to revoke. You do not have to prove your choice is the right one.

That cuts both ways. A revocation takes effect from the form you sign. So do not sign a revocation you did not ask for. Read each form put in front of you. Ask what it does in plain words. Ask if it ends hospice or just moves it to a new team. Those are not the same thing.

If you feel rushed, slow down. You can ask for a copy to read first. You can ask a family member or a trusted friend to read it with you. A signature is a strong act. Treat it that way, for a revocation and for a change alike.

Who pays for what

• Original Medicare pays for hospice care under the hospice benefit while your election is in place. Hospice care has no deductible (Ledger A14).
• You pay up to $5 for each outpatient prescription for pain relief and symptom control while on hospice (Ledger A14).
• You pay 5% of the Medicare-approved amount for inpatient respite care while on hospice (Ledger A14).
• After a revocation takes effect, regular Medicare cover resumes for the benefits you had given up. Regular Medicare cost rules apply to that care from that date.
• A change of hospice does not start a new benefit. The hospice benefit goes on with the new hospice, and the same hospice cost rules apply.
• Medicaid can help with some costs for people who qualify through their state. Ask your state office what it covers in your case.
• Private pay covers care Medicare does not cover, and costs you owe with no cover in place.

Sample situation

Rosa elected hospice in the fall. She has a life span of 6 months or less if her illness runs its normal course (Ledger B1). For a time, hospice care fit her needs well. She paid no deductible for hospice care. She paid up to $5 for each outpatient drug for pain care (Ledger A14). Then a new treatment came up that she wants to try. That treatment sits outside hospice care. Rosa and her son talk it over. She tells the hospice she wants to stop. The nurse brings the revocation form. Rosa reads it with care. It states that she revokes her election for the rest of that period. She picks an effective date that is the same day she signs. She signs the form and keeps a copy. From that date, hospice cover ends for that period. Her regular Medicare cover for the benefits she had given up comes back. She can now seek the new treatment under regular Medicare rules. Rosa knows she has given up the rest of that period. She also knows she may elect hospice again later for a period still open to her if her facts still fit.

What to check before you file

Start with the form in front of you. Read each line. Ask what date it sets and what cover it ends or moves. File it, keep your copy, and call the next team the same day so care does not stall.

• Do you want to stop hospice, or do you just want a new hospice? The first is a revocation. The second is a change.
• Have you used your one change in this election period yet?
• Does your signed statement state the act you want? If you revoke, does it give an effective date that is not before today?
• For a change, have you filed with both the old hospice and the new hospice, and does the statement name both?
• Do you hold a copy of each form you filed, with the date the hospice got it?
• If you revoke, do you know which regular Medicare care you want next, and who will give it?
• Did you sign only forms you asked for and read in full?

Sources

• https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.28
• https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.30