Coverage explainer · Montrose & Ouray counties, Colorado · Plan year 2026 and FY 2027 rates

Does Medicare cover hospice? The 2026 rules, what you pay, and who serves Montrose and Ouray counties

More than half of the people on Medicare who died in 2024 used hospice first. The benefit is one of Medicare's most complete, and one of its least understood: it is paid by Part A even if you have a Medicare Advantage plan, it costs almost nothing out of pocket, it is not limited to six months, and in the Uncompahgre Valley it is delivered by a small number of agencies whose service maps CMS publishes. This guide walks through the rules as they stand this fall, including a new patient notice every hospice must hand you starting October 1, 2026.

Bemis Insurance Data Desk

Reviewed by Trinity Bemis, Licensed Insurance Broker & Medicare Specialist (NPN 21424070) · Published 2026-10-05

The short answer

Yes. Medicare Part A covers hospice care for anyone certified by a hospice doctor as having a life expectancy of 6 months or less, who chooses comfort care over treatment meant to cure the illness. You pay nothing for the care itself, up to $5 per outpatient prescription, and 5% of the cost of short inpatient respite stays. The benefit is paid by Original Medicare whether or not you are in a Medicare Advantage plan, it continues past six months as long as you are recertified, and you can leave it at any time.

Medicare's own handbook puts the coverage this way: "All items and services you need for pain relief and symptom management," plus "medical, nursing, and social services," drugs and equipment for comfort, "aide and homemaker services," and "spiritual and grief counseling for you and your family." The rest of this article is the fine print under that paragraph, with the 2026 dollar figures, the payment rates that took effect October 1, 2026, and the hospice agencies CMS says actually drive to Montrose, Olathe, Ridgway and Ouray.

Sources: Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care · MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data) · CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), Colorado state row, retrieved October 5, 2026.

Who qualifies for Medicare hospice?

Four conditions, all from the handbook and the federal hospice regulation at 42 CFR Part 418:

1. You have Medicare Part A. Hospice is a Part A benefit; Part B and Part D are not required for it, though almost everyone has them.
2. Two doctors certify you are terminally ill. "A hospice doctor and your primary care doctor (if you have one) must certify that you're terminally ill, meaning you have a life expectancy of 6 months or less." The regulation adds the key phrase: "if the illness runs its normal course." This is a prognosis, not a prediction, and nobody is penalized when it turns out to be wrong.
3. You accept comfort care. "You accept (or agree to) comfort care (palliative care) instead of care to cure your terminal illness." Palliative care means treatment aimed at pain and symptoms rather than the disease. You are not giving up medical care; you are changing its goal.
4. You sign an election statement. It names the hospice and your attending physician, confirms you understand the palliative nature of the care, and waives Medicare payment for treatment of the terminal illness outside the hospice. Medicare continues to pay for everything unrelated to it.

Who decides what counts as "related" matters more than it sounds, and it is the reason for the new notice described below. Cancer, heart failure, COPD, dementia, Parkinson's, ALS, kidney failure and advanced liver disease are the common hospice diagnoses. Nationally in 2024, circulatory conditions accounted for 31% of hospice admissions, nervous system conditions including dementias for 26%, cancer for 23% and respiratory disease for 10%; Colorado's mix, in the table below, leans more toward dementia and other neurological illness.

Sources: Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care · eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance), §§418.3, 418.20, 418.22(b) and 418.24(b) · CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), national and Colorado rows, primary diagnosis shares.

What does the hospice benefit cover?

Once you elect hospice, Medicare.gov says, "your hospice benefit should cover everything you need" for the terminal illness and related conditions. In practice the hospice's interdisciplinary team writes a plan of care and provides or arranges:

• Doctor and nursing care, including a nurse on call around the clock. You may keep your own doctor or nurse practitioner as the "attending medical professional" if you name them on the election form.
• Drugs for pain and symptom management (your $5-or-less copayment applies when you take them at home).
• Durable medical equipment and supplies for comfort: a hospital bed, oxygen, a wheelchair, a commode, dressings.
• Hospice aide and homemaker services for bathing, personal care and light housekeeping.
• Physical, occupational and speech therapy, dietary counseling, and social work as the plan of care calls for them.
• Spiritual and grief counseling for you and your family, including bereavement support after a death.
• Short-term inpatient care for symptoms that cannot be managed at home, and inpatient respite care so a family caregiver can rest, "for up to 5 days each time."

Three things are not covered. Treatment intended to cure the terminal illness, and drugs meant to cure it. Care from a hospice or provider you did not choose through your hospice, unless it is for something unrelated or an emergency. And room and board: "Medicare won't pay room and board for your care in a facility, unless the hospice medical team decides you need short-term inpatient care to manage pain and other symptoms." If you live in a nursing home or assisted living, hospice comes to you there, but the facility bill stays yours (or Health First Colorado's, if you qualify for Medicaid long-term care).

Hospice does not replace your other Medicare coverage. "Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions." A broken wrist, a dental infection, an eye exam: those are billed to Medicare, or to your Medicare Advantage plan, exactly as before, with the usual deductibles and coinsurance. Our home health guide covers the separate, non-hospice home care benefit many families use first.

Sources: Medicare.gov — Hospice care coverage · Medicare.gov — How hospice works · Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care, page 29.

What do I pay for hospice in 2026?

Very little, and the amounts are set by federal regulation rather than by the hospice.

Sources: Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care · eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance), §§418.400 and 418.402 · Medicare.gov — Medicare costs (plan year 2026) · respite dollar figure calculated as 5% of the $545.93 FY 2027 national inpatient respite rate in CMS Transmittal 13976; the actual amount is wage-adjusted for the hospice's location.

Medigap and hospice. Every standardized Medigap plan covers the "Part A hospice care coinsurance or copayment," meaning the drug copayments and respite coinsurance above: in full under Plans A, B, C, D, F, G, M and N, and at 50% under Plan K and 75% under Plan L. So most Medigap policyholders pay nothing at all for hospice. Our Medigap versus Medicare Advantage comparison explains the rest of what the plans cover.

Source: Medicare.gov — Choosing a Medigap Policy (CMS Product No. 02110, March 2026), Medigap benefits chart, Medigap benefits chart.

What are the four levels of hospice care?

Medicare pays hospices a flat daily rate that depends on the level of care you need that day, not on how many visits you get. Knowing the four levels helps families understand what to ask for when a bad night turns into a crisis. The national rates below took effect October 1, 2026, for fiscal year 2027, after a 2.3% update; CMS adjusts each one for local wages, so the Montrose figure differs slightly. You do not pay these amounts; they show what Medicare is buying on your behalf.

Sources: CMS — Transmittal 13976 / Change Request 14557, Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2027 (September 30, 2026), Table 1 · CMS.gov — Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) fact sheet, July 30, 2026 · eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance), §§418.204 and 418.302 · MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data). Rates are for hospices that report quality data; non-reporters are paid 4 percentage points less.

Nationally and in Colorado, 99% of hospice days in fiscal 2024 were routine home care days. The other three levels are safety valves, and whether a hospice can actually deliver them in a rural county depends on having contracts with a local hospital or nursing facility. That is a fair question to ask any hospice in the Uncompahgre Valley: where would general inpatient or respite care happen, and how far would my family drive?

The aggregate cap. Medicare also limits what a hospice can be paid per patient on average across a year, $36,174.75 for the cap year that began October 1, 2026. The cap applies to the hospice, not to you, and it is one of the program's checks on agencies that admit people who are not really eligible. MedPAC estimates about 28% of hospices nationally exceeded it in 2023, concentrated in four other states; Colorado is not one of them.

Sources: CMS — Transmittal 13976 / Change Request 14557, Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2027 (September 30, 2026) · CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), routine home care share · MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data), Table 10-5.

How long can I stay on hospice?

As long as you remain eligible. The six-month figure is an entry test, not a time limit. Coverage runs in benefit periods set by regulation: "An initial 90-day period; a subsequent 90-day period; or an unlimited number of subsequent 60-day periods." At the start of each period the hospice must obtain a new written certification that your life expectancy is still 6 months or less if the illness runs its normal course.

The face-to-face visit. Before your third benefit period, and before every period after it, "a hospice physician or hospice nurse practitioner must have a face-to-face encounter" with you, "prior to, but no more than 30 calendar days prior to," the recertification. Through at least December 31, 2027, that visit may happen by two-way video if it is solely for recertification, with exceptions for hospices under enhanced oversight. For a Ridgway or Nucla family whose hospice is based in Grand Junction or Montrose, the video option can be the difference between a recertification done on time and one done late.

What the data say about length of stay. MedPAC's March 2026 report found that among Medicare beneficiaries who died in 2024, the average lifetime hospice stay was 99.6 days but the median was only 19 days. Half of all hospice patients, in other words, were enrolled for less than three weeks. Stays were longest for neurological conditions (169 days) and COPD (133 days) and shortest for cancer (51 days); longer in assisted living (174 days) and nursing facilities (120 days) than at home (100 days). Both ends of that distribution are a problem: very late referrals mean families get days of support instead of months, while very long stays draw program-integrity scrutiny. If a doctor raises hospice, the useful question is not "how long do I have" but "would I qualify now."

Sources: eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance), §§418.21 and 418.22(a)(4) · MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data) · CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), share of hospice beneficiaries by primary diagnosis chapter, Colorado and national rows, retrieved October 5, 2026.

What if I have Medicare Advantage or Medigap?

This is the question we hear most, and the answer surprises people. Hospice is carved out of Medicare Advantage. The handbook: "Original Medicare will be billed for your hospice care, even if you're in a Medicare Advantage Plan (and you aren't required to switch back to Original Medicare for it to cover hospice care). When you get hospice care, your Medicare Advantage Plan can still cover services that aren't part of your terminal illness or any conditions related to your terminal illness."

What that means in practice for the roughly 44% of Montrose County beneficiaries and 28% of Ouray County beneficiaries who are in Medicare Advantage or another Medicare health plan:

• You can use any Medicare-certified hospice. The plan's network does not apply to hospice, and no prior authorization from the plan is needed. The hospice bills Original Medicare directly.
• You stay in the plan. You keep paying its premium, if any, and it keeps covering unrelated care, your Part D drugs and extras such as dental or the over-the-counter allowance. Unrelated care still follows the plan's network and copay rules.
• If you leave hospice alive, Original Medicare pays for your Part A and Part B services through the end of that calendar month; on the first of the next month the plan resumes responsibility for everything.
• You may switch plans during hospice if you want to. The usual enrollment windows apply: Open Enrollment October 15 to December 7, the Medicare Advantage Open Enrollment Period January 1 to March 31, and any Special Enrollment Period you qualify for.

Original Medicare plus Medigap is simpler still: Part A pays the hospice, the Medigap policy picks up the drug copays and respite coinsurance, and nothing about your other coverage changes. The 7,323 Montrose County and 1,227 Ouray County residents in Original Medicare in 2025 are already set up this way. For a fuller look at how networks and prior authorization work outside hospice, see our Montrose County HMO and PPO network guide.

Sources: Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care, page 29 · MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data), endnote 6 on Medicare Advantage enrollees and live discharge · CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county rows: Montrose County 13,032 beneficiaries, 7,323 in Original Medicare; Ouray County 1,694 and 1,227; shares calculated from those counts.

What rights do I have on hospice?

The hospice regulation gives patients and their representatives five specific rights worth knowing before you sign.

1. To choose and to change your hospice. "An individual or representative may change, once in each election period, the designation of the particular hospice from which hospice care will be received." The change is not a revocation; your benefit period simply continues with the new agency.
2. To stop hospice at any time. You "may revoke the individual's election of hospice care at any time during an election period" by filing a signed statement with the hospice. Medicare coverage of curative treatment resumes immediately, and you may elect hospice again later for any remaining benefit periods. People do this to try a new treatment, or because they improved.
3. To keep your own doctor. Medicare.gov: "you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional" on the election form.
4. To a written list of what the hospice will not cover. For elections on or after October 1, 2026, the hospice "must provide the individual (or representative) an election statement addendum" titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." It must list your conditions present on admission and the items, services and drugs the hospice has decided are unrelated to the terminal illness, with "a written clinical explanation, in language the individual (or representative) can understand." Until this fall the addendum was given only on request; the FY 2027 rule made it mandatory. Signing it "is only acknowledgement of receipt," not agreement.
5. To immediate advocacy if you disagree. The addendum must tell you that "immediate advocacy is available through the Medicare Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO)" if you disagree with the hospice's determination. The BFCC-QIO's contact information must be on your election paperwork; 1-800-MEDICARE can also route you there. Our Medicare appeals guide covers the formal appeal process that sits behind it.

The hospice has rights too. It may discharge you if you move out of its service area, if it "determines that the patient is no longer terminally ill," or for cause after documented efforts to resolve a problem. A discharge for improvement is not a failure; it is the regulation working as written, and you can be readmitted if your condition declines again.

Sources: eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance), §§418.24(b)(6) and (c), 418.26, 418.28 and 418.30 · Medicare.gov — How hospice works · CMS.gov — Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) fact sheet, July 30, 2026.

Which hospices serve Montrose and Ouray counties?

CMS publishes, for every Medicare-certified hospice, the list of zip codes it says it serves. The August 2026 file shows the Uncompahgre Valley is served by a handful of agencies, most of them based elsewhere:

Source: CMS Provider Data — Hospice: Zip Data (zip codes where each Medicare-certified hospice provides services), August 2026, queried by zip code on October 5, 2026; names and ownership from CMS Provider Data — Hospice: General Information (ownership, certification date, county), August 2026. Hospices update their service areas; confirm with the agency and on Care Compare.

A few things stand out in CMS's records. HopeWest, a non-profit certified in 1993 and headquartered in Grand Junction, is the only hospice listing Ouray and Ridgway, and it served 1,723 Medicare beneficiaries across 152,500 days of care in fiscal 2024, 16% of them rural residents. The federal file lists each hospice by its certified headquarters, so any local branch offices do not appear separately. Touch of Care Hospice is the one agency actually headquartered in Montrose County, a for-profit certified in 2019 that served 46 Medicare patients in fiscal 2024. Hospice of the Valley, a Glenwood Springs non-profit, lists Montrose 81401 and served 172 patients statewide. Abode Hospice of Colorado, a for-profit based in Grand Junction, lists the 81403 zip code only.

Medicare also publishes what families say about each hospice after a death, through the CAHPS Hospice Survey. Two of the local agencies have enough responses to be scored; Touch of Care does not yet, which is common for small agencies and is not a mark against them.

Sources: CMS Provider Data — Hospice care: Provider CAHPS Hospice Survey Data, August 2026 · CMS Provider Data — Hospice care: State CAHPS Hospice Survey Data (Colorado averages), August 2026 · CMS Provider Data — Hospice care: National CAHPS Hospice Survey Data, August 2026, retrieved October 5, 2026. HopeWest's family caregiver survey star rating is 4 of 5; Hospice of the Valley's and Touch of Care's are not available. Survey results reflect each agency's whole service area, not Montrose or Ouray counties alone. Utilization figures from CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), provider rows.

Two cautions on reading this. First, a hospice's survey scores describe past families' experience, not what yours will be, and the differences between agencies above are a few percentage points on surveys with their own margins of error. Second, MedPAC reports that the number of rural hospices has fallen about 1% a year since 2019 while urban, for-profit agencies have multiplied; in a county with one or two options, the practical questions, which we list below, matter more than the rankings.

Why it matters here

Hospice referrals follow the diseases that end lives, and CDC's county estimates show how common those diseases already are among adults in the two counties. Ouray County has the highest share of adults who have ever been diagnosed with cancer of any county in the region, a reflection in part of its older population; Montrose County has higher rates of heart disease, COPD, stroke and disability.

Source: CDC PLACES — Local Data for Better Health, County Data, 2025 release, "Cancer (non-skin) or melanoma among adults," model-based crude prevalence, 2023 BRFSS data year, retrieved through the Ambrose Brain cdc_county_health tool and confirmed against the CDC Socrata endpoint on October 5, 2026.

Source: CDC PLACES — Local Data for Better Health, County Data, 2025 release, crude prevalence among all adults, not Medicare beneficiaries only. Crude rates are shown because they describe the actual population a hospice serves; age-adjusted rates for both counties are lower.

Set against 13,032 Medicare beneficiaries in Montrose County and 1,694 in Ouray County in 2025, with an average hospice patient age of 83 statewide, the arithmetic is plain: most families in both counties will deal with a hospice decision for someone they love, and most will do it on short notice. Knowing in advance that the benefit is paid by Part A regardless of plan, that it does not stop at six months, and that only one agency lists Ridgway and Ouray, takes some of the scramble out of a hard week.

Sources: CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county rows · CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov), Colorado average beneficiary age.

Seven questions to ask before you sign

1. "Do you serve my zip code, and how far is your nearest nurse?" CMS's list is a starting point; ask about actual response times to Ridgway, Nucla or Olathe at 2 a.m.
2. "Where would general inpatient or respite care happen?" Ask which hospital or nursing facility the hospice contracts with and how far away it is.
3. "Can my own doctor stay involved as attending physician?" The election form has a place for the name. Decide this before signing, not after.
4. "What is on my Patient Notification of Non-Covered Items?" Read the addendum, ask about any drug you take that is not on the covered list, and remember that signing it means you received it, not that you agree.
5. "Which of my current medications will you continue?" Hospices often stop drugs aimed at long-term prevention. Ask why, drug by drug, and ask what the copay will be on the ones they cover.
6. "If I have Medicare Advantage, who do I call for unrelated care?" The plan still handles it. Keep the plan card and the hospice's number together.
7. "What happens if I get better?" You can be discharged and readmitted, or revoke on your own. Ask how the hospice handles both.

Colorado's State Health Insurance Assistance Program counselors, reached through the Division of Insurance, answer hospice and Medicare questions at no charge and are the right call if a hospice or a plan gives you an answer that does not match this article. Medicare.gov's Care Compare lets you search hospices by zip code and read the full survey results. An independent agent can help with the Medicare coverage around hospice, within the plans that agent offers; the hospice itself is your choice, not ours.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Bemis Insurance is a licensed independent insurance agency. Not connected with or endorsed by the United States government or the federal Medicare program. This is education, not advice — confirm plans, costs, and eligibility with a licensed agent or Medicare.gov. Bemis Insurance does not provide, arrange or recommend hospice services; hospice agencies named here are listed from public CMS records for information only.

Sources

• Medicare.gov — Medicare & You 2027, the official U.S. government Medicare handbook (CMS Product No. 10050, September 2026), pages 28–29, Hospice care
• Medicare.gov — Hospice care coverage
• Medicare.gov — How hospice works
• Medicare.gov — Medicare costs (plan year 2026)
• Medicare.gov — Choosing a Medigap Policy (CMS Product No. 02110, March 2026), Medigap benefits chart
• eCFR — 42 CFR Part 418, Hospice Care (Subpart B election and certification; §418.204 special coverage requirements; §418.302 payment categories; §418.400 coinsurance)
• CMS.gov — Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) fact sheet, July 30, 2026
• Federal Register — Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements (final rule, August 3, 2026; effective October 1, 2026)
• CMS — Transmittal 13976 / Change Request 14557, Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2027 (September 30, 2026)
• MedPAC — March 2026 Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (2024 data)
• CMS — Medicare Post-Acute Care Utilization: Hospice by Geography and Provider, FY 2024 (data.cms.gov)
• CMS Provider Data — Hospice: Zip Data (zip codes where each Medicare-certified hospice provides services), August 2026
• CMS Provider Data — Hospice: General Information (ownership, certification date, county), August 2026
• CMS Provider Data — Hospice care: Provider CAHPS Hospice Survey Data, August 2026
• CMS Provider Data — Hospice care: State CAHPS Hospice Survey Data (Colorado averages), August 2026
• CMS Provider Data — Hospice care: National CAHPS Hospice Survey Data, August 2026
• Medicare.gov — Care Compare (find and compare Medicare-certified hospices)
• CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county rows
• CDC PLACES — Local Data for Better Health, County Data, 2025 release
• Colorado Division of Insurance — Senior health care and Medicare (State Health Insurance Assistance Program)
• Medicare.gov — Find health & drug plans