Hospice became a Medicare benefit on November 1, 1983, when coverage authorized by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) took effect. The original law included a sunset that would have ended coverage in 1986, but Congress removed that expiration in 1985 and made hospice a permanent part of Medicare Part A.
TEFRA 1982 Authorized the Benefit
Section 122 of the Tax Equity and Fiscal Responsibility Act of 1982 (Public Law 97-248) added hospice care to the list of services Medicare would cover for terminally ill beneficiaries. The statute passed in 1982, but coverage did not begin the moment the president signed the bill. Congress and the agency that runs Medicare needed time to write the rules, set payment rates, and define what a Medicare-certified hospice would look like.
The implementing final rule appeared in the Federal Register on August 22, 1983, with an effective date of November 1, 1983. That November 1 date is the moment Medicare Part A beneficiaries with a terminal prognosis could first elect hospice care in place of curative treatment for their illness. So the answer depends on what you mean: Congress created the benefit in 1982, and patients could actually use it starting in late 1983.
A Sunset Was Built Into the Original Law
The 1982 statute did not make hospice a permanent Medicare service. Congress limited coverage to the period from November 1, 1983, through September 30, 1986. Lawmakers wanted a defined trial window to see how the benefit performed, how much it cost, and whether patients and providers used it as intended before committing indefinitely.
COBRA 1985 Made Hospice Permanent
Before the 1986 sunset arrived, Congress acted. Title IX of the Consolidated Omnibus Budget Reconciliation Act of 1985 (Public Law 99-272) struck the sunset provision and raised the daily payment rate for hospice care. From that point forward, hospice has been a permanent covered service under Medicare Part A.
If you are looking for a single year when hospice “became” Medicare, 1985 is the strongest candidate, because that is when the benefit stopped being a time-limited experiment and became a durable part of the program. The 1982 and 1983 dates mark authorization and the start of coverage; 1985 marks permanence.
Refinements After 1985
Congress kept adjusting the benefit in the decades that followed. The Balanced Budget Act of 1997 revised the hospice benefit periods and updated payment structures. Medicaid separately added hospice as an optional benefit that states could offer under their Medicaid plans, extending comparable coverage beyond the Medicare population.
The Centers for Medicare and Medicaid Services later added a requirement that a hospice physician or nurse practitioner conduct a face-to-face encounter with the patient before the third benefit period and each period after that, to confirm the patient still meets the terminal prognosis. That change reflected an ongoing effort to keep eligibility reviews meaningful over long hospice stays. None of these later adjustments changed the basic answer about when Medicare hospice began; they refined a benefit that was already in place.
Where the American Hospice Model Came From
The Medicare hospice benefit did not appear from nowhere in 1982. The modern hospice movement started in the United Kingdom, where Dame Cicely Saunders opened St. Christopher’s Hospice in London in 1967. Her model inspired Florence Wald, a former dean of Yale University’s School of Nursing, to launch the first hospice home-care program in the United States in Branford, Connecticut, in the mid-1970s.
Early American hospices operated outside traditional hospital settings and relied heavily on charitable funding and volunteers. They focused on pain management, emotional support, and dignity for dying patients rather than curative treatment. Through the late 1970s, grassroots hospice programs multiplied, and the federal government sponsored demonstration projects to study whether hospice care could work inside Medicare. Those pilots produced the evidence Congress relied on when it wrote Section 122 of TEFRA.
Timeline at a Glance
- 1967: St. Christopher’s Hospice opens in London, launching the modern hospice movement.
- Mid-1970s: Florence Wald opens the first U.S. hospice home-care program in Branford, Connecticut.
- 1982: Congress passes TEFRA (Public Law 97-248), authorizing a Medicare hospice benefit with a sunset in 1986.
- August 22, 1983: The final implementing rule is published in the Federal Register.
- November 1, 1983: Medicare hospice coverage takes effect for eligible Part A beneficiaries.
- 1985: COBRA (Public Law 99-272) removes the sunset and makes hospice a permanent Part A benefit.
- 1997: The Balanced Budget Act revises benefit periods and payment structures.
What the Benefit Looks Like Today
Since 1983, the Medicare hospice benefit has covered a broad set of comfort-focused services for beneficiaries whose attending physician and a hospice medical director both certify a terminal illness with a life expectancy of six months or less if the disease follows its expected course. The patient must be enrolled in Medicare Part A and must sign an election statement choosing hospice in place of curative treatment for the terminal illness and related conditions.
Coverage is organized into two initial 90-day certification periods followed by an unlimited number of 60-day periods for the rest of the patient’s life, as long as eligibility continues. Out-of-pocket costs are limited: up to $5 per prescription for outpatient drugs used for pain and symptom management, and 5 percent of the Medicare-approved amount for inpatient respite care, capped at the annual inpatient hospital deductible. Room and board at a nursing home or assisted living facility is not covered. A patient can revoke the hospice election at any time and return to standard Medicare, and can re-elect hospice later if the illness progresses.
Those details have shifted at the edges since 1983, but the core framework Congress built in TEFRA and locked in through COBRA is the one still in use today.