Yes, you can refuse hospice care. Every competent adult in the United States has the legal right to decline it, and no doctor, hospital, or family member can force it on you. The harder question is what that refusal means for your Medicare coverage, your out-of-pocket costs, and the kinds of care that remain available to you afterward.
The Legal Right to Say No
The right to refuse medical treatment rests on patient autonomy, informed consent, and constitutional protection. In Cruzan v. Director, Missouri Department of Health, the U.S. Supreme Court recognized that the Fourteenth Amendment’s Due Process Clause protects a person’s liberty interest in refusing unwanted medical treatment.1Justia Law. Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990) That principle covers hospice as much as any other intervention.
Congress reinforced it through the Patient Self-Determination Act. Every hospital, skilled nursing facility, home health agency, and hospice program that participates in Medicare must give adult patients written information about their right under state law to accept or refuse medical treatment.2Office of the Law Revision Counsel. 42 U.S. Code 1395cc – Agreements With Providers of Services Facilities cannot condition care on whether you signed an advance directive, and a hospital cannot discharge you prematurely because you turned down a hospice referral.
The right holds even when refusal may lead to a faster decline. Forcing unwanted care on a competent adult can constitute assault or battery. Providers should confirm your decision is informed. They cannot override it.
How to Actually Refuse
The mechanics are simple. When a physician or hospice agency recommends hospice, you or your authorized decision-maker communicates the refusal directly, usually in a conversation. There is no court filing and no waiting period.
After a verbal refusal, the provider will often ask you to sign a “Refusal of Treatment” form. Signing isn’t legally required for your refusal to take effect. The form documents that hospice was offered, that the consequences of declining were explained, and that you chose to decline. If you don’t want to sign, the provider can note the verbal refusal in your chart instead.
When a Hospital Pushes Hospice at Discharge
The situation gets more delicate when hospice appears as part of a discharge plan. If you have Medicare and disagree with the hospital’s decision to discharge you, you have the right to an expedited appeal. The hospital must give you an “Important Message from Medicare” notice explaining the process. File the appeal with your regional Quality Improvement Organization by midnight on the day of your planned discharge. The organization typically responds within 24 hours, and the hospital generally cannot discharge you during that review.
What Refusing Hospice Costs You Under Medicare
This is the part most people don’t fully see coming. The Medicare hospice benefit is unusually generous, and walking away from it means walking back into standard cost-sharing.
What Hospice Would Have Paid For
Electing the Medicare hospice benefit covers nearly everything tied to your terminal illness with very little out-of-pocket cost: nursing care, physician visits, medications for pain and symptom control, medical equipment, physical and occupational therapy, social work, counseling for you and your family, and short-term inpatient stays for pain control or respite. Your copay for hospice medications is capped at $5 per prescription, and respite care coinsurance is 5% of the Medicare payment rate for that day.3Centers for Medicare & Medicaid Services. Hospice
The tradeoff is that electing hospice requires you to waive Medicare-covered curative treatment for the terminal condition. Coverage for unrelated conditions continues, but treatments aimed at curing or slowing the terminal illness are off the table while you’re enrolled.
What You Pay Without Hospice
If you refuse hospice and stay with standard Medicare, curative treatment remains available and normal cost-sharing returns. For 2026, the Part A hospital deductible is $1,736 per benefit period, with coinsurance kicking in for extended stays.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles Part B carries a $283 annual deductible followed by 20% coinsurance on most covered services.5Centers for Medicare & Medicaid Services. MM14279 – Medicare Deductible, Coinsurance and Premium Rates CY 2026 Update For someone with a serious terminal illness undergoing active treatment, those numbers add up quickly.
Medicaid works on the same logic: electing hospice means waiving Medicaid coverage for curative treatment of the terminal condition. The exception is for patients under 21, who can receive both hospice and curative treatment at the same time without waiving anything.6Medicaid.gov. Hospice Benefits
What Care Is Still Available
Refusing hospice does not mean refusing care. Two paths remain wide open.
The first is continuing curative treatment. Standard Medicare or private insurance still pays for interventions aimed at fighting the underlying disease. You lose access to hospice-specific services such as counseling, respite care, and coordinated home-based support, and you pick up the deductibles and coinsurance above.
The second is palliative care, which is often confused with hospice but works differently. Palliative care focuses on relieving symptoms and improving quality of life for people with serious illnesses, and it can be provided alongside curative treatment at any stage. You don’t need a terminal diagnosis, and you don’t waive any insurance benefits. A palliative care team usually includes doctors, nurses, and social workers who coordinate with your existing providers. Medicare Part B covers palliative care consultations and related services under its standard cost-sharing rules, so the $283 deductible and 20% coinsurance apply.5Centers for Medicare & Medicaid Services. MM14279 – Medicare Deductible, Coinsurance and Premium Rates CY 2026 Update
For a lot of people the choice isn’t permanent. Palliative care can carry you through the period when you’re still deciding, and hospice remains available whenever you’re ready.
If You Change Your Mind Later
Refusing hospice up front leaves the door open. So does leaving hospice after you’ve started, though revocation has a specific procedure under federal regulation.
To revoke a hospice election, the patient or their representative must file a signed written statement with the hospice agency. A phone call or verbal request is not enough. The statement must include the date the revocation takes effect, and that date cannot be earlier than the date the statement is signed.7eCFR. 42 CFR 418.28 – Revoking the Election of Hospice Care Once revocation takes effect, standard Medicare coverage resumes for the benefits that had been waived.8Centers for Medicare & Medicaid Services. Pub 100-02 Medicare Benefit Policy – Updates on Hospice Election Form, Revocation, and Attending Physician
You can re-elect hospice later if you still meet the criteria. A physician must certify that life expectancy is six months or less if the illness runs its normal course.9eCFR. 42 CFR 418.22 – Certification of Terminal Illness The Medicare hospice benefit is structured as two 90-day benefit periods followed by an unlimited number of 60-day periods, and after six months of hospice care, continued coverage requires recertification through a face-to-face assessment with a hospice physician or nurse practitioner.10Medicare.gov. Hospice Care Coverage
When Someone Else Is Making the Decision
Everything above assumes the patient can speak for themselves. When they can’t, a healthcare power of attorney lets an appointed agent make medical decisions, including whether to accept or refuse hospice. A living will provides direct written instructions about specific treatments. Without either, state law sets a default hierarchy of surrogates that typically runs from spouse to adult children to parents to siblings, with variation by state.
The law presumes every adult is competent to make their own medical decisions unless a clinical assessment or court determination says otherwise. Decision-making capacity is a clinical judgment made by a physician or licensed psychologist, and it’s different from legal competency, which only a court can decide. Capacity is assessed for a specific decision at a specific time; a patient with dementia or mental illness can still have capacity to accept or refuse a particular treatment. When families and clinical teams disagree, hospitals often involve an ethics committee, whose input is advisory. Genuine deadlocks that can’t be resolved that way move to court through a guardianship petition.