Benefit Period Election

Benefit period election is the patient's formal, voluntary choice to receive the Medicare hospice benefit for a defined coverage period. The benefit is structured as two 90-day periods followed by an unlimited number of 60-day periods (42 CFR 418.21)^[1].

An individual may elect hospice care during an initial 90-day period, a subsequent 90-day period, and then an unlimited number of subsequent 60-day periods, elected in that order (42 CFR 418.21(a), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.21). Election is made by filing an election statement that identifies the hospice, acknowledges that the patient understands the palliative rather than curative nature of hospice care, waives Medicare payment for curative treatment of the terminal illness and related conditions, and sets an effective date no earlier than the date of election (42 CFR 418.24(b), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24). The hospice must obtain a written certification of terminal illness for each period, even when a single election continues across an unlimited number of periods (42 CFR 418.21(b)). To establish the election on the Medicare claims record the hospice files a Notice of Election (NOE) with its Medicare Administrative Contractor, and it files a Notice of Termination/Revocation (NOTR) when an election ends without a final claim — both defined in the Billing & RCM category. A patient may revoke the election or transfer to a different hospice once per benefit period without the transfer counting as a revocation.

The election date sets the clock for nearly every downstream deadline: NOE filing, certification and face-to-face windows, and the two-tier routine home care rate that pays more in a patient's first 60 days than after day 61. A late or defective election, or a gap between the election date and a timely NOE, shifts financial liability to the hospice for the untimely days, which become provider-liable rather than Medicare-payable. Because each period requires its own certification, a disciplined election-and-recertification calendar determines whether episodes are clean or accumulate non-covered days. Election also waives curative Medicare coverage only for the terminal diagnosis and related conditions, so mapping "related versus unrelated" at election protects both the patient and the hospice.