Guidelines in determining patient eligibility under the Medicare/Medicaid Hospice Benefit are helpful by identifying those persons that may have a life expectancy of approximately six months or less. A patient will need to meet all of the following criteria to be eligible for hospice:

Coverage of hospice care depends upon a physician's certification that a person's life expectancy is six months or less if the illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, the National Hospice and Palliative Care Organization has published medical criteria for determining prognosis of certain diagnoses. These guidelines form a reasonable approach to the determination of life expectancy based on available research.

If a patient meets the medical criteria, they are, by definition, eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care because of other co-morbidities or rapid functional decline. It is the physician's clinical judgment regarding the normal course of the individual's illness determines a prognosis of six months or fewer.