Part D Hospice Rules: Which Drugs Are Covered?

When someone elects Medicare hospice care, families often ask: who pays for the medications now? Drugs tied to the terminal illness move to the hospice benefit, while drugs for unrelated conditions usually stay with Part D. Knowing which bucket each prescription falls into prevents surprise bills and pharmacy delays.

Electing hospice does not cancel your Part D plan

Choosing hospice does not end your Part D coverage. Your plan stays in place, but its role shrinks: once you elect the hospice benefit, Part D stops paying for drugs related to your terminal illness or its symptoms, and keeps covering drugs completely unrelated to it, under your plan's normal rules and cost-sharing. The same person can have some prescriptions paid by hospice and others by Part D — it all comes down to why each drug was prescribed.

What the hospice benefit pays for

The Medicare hospice benefit is part of Medicare Part A. It covers comfort care for a person with a terminal illness, when a doctor and the hospice medical director certify a life expectancy of six months or less if the illness runs its normal course. The hospice receives a daily payment from Medicare and uses it to provide the services in the patient's plan of care, including drugs for pain relief and symptom control related to the terminal illness. Common examples include:

• Pain relievers, including opioids, for pain and shortness of breath
• Anti-nausea medications
• Laxatives and bowel-care medications
• Anti-anxiety medications for anxiety, agitation, and restlessness
• Other drugs the hospice team determines are needed for comfort

For these outpatient drugs, you generally pay nothing, though the hospice may charge up to $5 per prescription for drugs used for pain relief and symptom management. Drugs are never covered by both the hospice benefit and Part D at once — one payer covers each prescription, not both.

The four drug categories that need a second look

Medicare treats four categories of drugs as nearly always related to hospice care: pain relievers, anti-nausea drugs, laxatives, and anti-anxiety drugs. If your doctor prescribes one of these for a reason unrelated to your terminal illness, your Part D plan will require prior authorization before it pays.

In practice, the prescriber or hospice provider must tell the Part D plan that the drug is unrelated to the terminal illness. Until that notice arrives, the claim may be rejected at the pharmacy — not because the drug is excluded, but because the plan has no confirmation that hospice is not supposed to pay for it. If a prescription is delayed, call the hospice first: sending that notice is usually its job. For drugs outside those four categories, the same principle applies, but the plan is less likely to hold the claim automatically.

What Part D still covers during hospice

Part D keeps paying for medications for conditions unrelated to the terminal illness — for example, a person on hospice for cancer might still have Part D cover a long-standing blood pressure medicine or diabetes drug.

For those drugs, normal Part D cost-sharing still applies. In 2026, covered Part D drugs have a $2,100 annual out-of-pocket cap, after which you pay $0 for covered drugs for the rest of the year. That cap still applies to the unrelated drugs Part D covers during hospice. The drug must also be on your plan's formulary or approved through an exception, and any prior authorization or step therapy requirements still apply.

What hospice does not cover

Hospice is comfort care, not curative care. When you elect hospice, you give up Medicare coverage for treatments intended to cure the terminal illness. Drugs meant to cure or slow it — such as chemotherapy aimed at shrinking a tumor — are generally not covered, by hospice or by Part D, while the election is in effect.

If your goals change, you can revoke the hospice election at any time. Once you revoke, or you are discharged, your Part D plan should cover all of your drugs again. Bring documentation of the revocation or discharge to the pharmacy so claims are not delayed.

How long hospice coverage lasts

Hospice care is organized into benefit periods: two initial 90-day periods, followed by an unlimited number of 60-day periods, as long as you remain eligible and are recertified each period. There is no lifetime limit, and the drug coverage rules stay the same across periods.

If a drug claim is denied

A denial during hospice usually comes down to three causes: the plan believes the drug is hospice-related, the drug is not on the formulary, or a required prior authorization is missing. Steps to take:

1. Ask the hospice team whether the drug is classified as related or unrelated to the terminal illness.
2. If it is unrelated, ask the hospice or prescriber to notify the Part D plan in writing.
3. If the drug is not on the formulary, ask your prescriber about a formulary exception or a covered alternative.
4. If the denial stands, appeal through your plan's exceptions and appeals process.

Bottom line: During hospice, the hospice benefit pays for drugs that manage pain and symptoms of the terminal illness (with at most a $5 copay per outpatient prescription), while Part D keeps covering drugs for unrelated conditions — so ask the hospice team which payer covers each prescription.