Washington Programs

End-of-life care, hospice, and Washington's Death with Dignity Act

Medicare Part A covers hospice care for people with a life expectancy of six months or less who choose comfort care. Washington's Death with Dignity Act (RCW 70.245) separately lets terminally ill, competent adult residents request medication to end their lives; federal law bars Medicare from paying for that medication, but people who use the law can still receive hospice.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 9, 2026

Medicare's hospice benefit

Medicare Part A covers hospice care for people with a terminal illness and a life expectancy of six months or less if the illness runs its normal course. Hospice focuses on comfort rather than cure. Medicare's hospice benefit covers the services in your plan of care, including:

Nursing care and doctor services
Medical equipment and supplies, such as a hospital bed or oxygen
Drugs for pain and symptom management
Hospice aide and homemaker services
Social work services, dietary counseling, and spiritual support
Short-term inpatient care for pain and symptom management
Inpatient respite care, to give a family caregiver a rest
Grief and loss support for you and your family

You pay nothing for covered hospice care from a Medicare-approved hospice. You may owe a small copayment for each outpatient prescription for pain and symptom control, and 5% of the Medicare-approved amount for inpatient respite care. Medicare does not pay room and board, whether you live at home, in a nursing home or in an inpatient hospice facility. Most hospice care happens where you live.

Choosing hospice

Hospice is a benefit you choose. To qualify under Medicare:

Your hospice doctor and your regular doctor (if you have one) certify a life expectancy of six months or less
You accept comfort care instead of care to cure your illness
You sign a statement choosing hospice instead of other Medicare-covered treatment for your terminal illness
You get care from a Medicare-approved hospice

Once hospice starts, Medicare stops covering treatment meant to cure the terminal illness. It still covers care for health problems unrelated to it, under the usual deductibles and coinsurance. For example, if you are in hospice for cancer, Original Medicare still covers treatment for an unrelated broken hip.

You can stop hospice at any time and return to regular Medicare coverage, and elect hospice again later if you qualify. You can also change hospice providers once in each benefit period.

Finding hospice in Washington

Medicare-approved hospices serve communities across Washington, from nonprofit community hospices to hospital-affiliated programs. To find hospices that serve your area and compare them, use Medicare's Care Compare tool or ask your doctor or hospital discharge planner. If you have Apple Health, hospice is also covered under most Apple Health programs.

The Washington Death with Dignity Act

Washington voters approved the Death with Dignity Act as Initiative 1000 on November 4, 2008, and it took effect on March 5, 2009. Washington was the second state, after Oregon, to pass such a law by ballot measure. The law, chapter 70.245 RCW, allows a competent adult Washington resident with a terminal disease expected to cause death within six months to request medication they may take themselves to end their life.

Eligibility

Washington resident. Factors that show residency include a Washington driver's license, voter registration in Washington, or owning or leasing property in Washington.
18 years old or older
Competent: able to make and communicate an informed health care decision
A terminal disease, medically confirmed, expected to produce death within six months
Age or disability alone does not qualify anyone

Process

An oral request and a written request to the attending provider, then a second oral request at least 7 days after the first (a 2023 law cut this from 15 days)
The written request is signed in front of two witnesses; at least one may not be a relative, an heir, or an owner, operator or employee of the patient's health care facility
Since 2023, the attending and consulting providers may be physicians, physician assistants or advanced registered nurse practitioners ("qualified medical providers")
The consulting provider confirms the diagnosis and prognosis and that the patient is competent
If either provider thinks the patient's judgment may be impaired by a psychiatric or psychological disorder or depression, the patient is referred for a mental health evaluation before any prescription
The patient takes the medication themselves, if and when they choose; they can rescind the request at any time

Participation is voluntary for patients and for health care providers. The Washington State Department of Health (DOH) collects required forms from providers and pharmacists. After the 2025 legislative session, DOH paused its annual statistical reports on the law for budget reasons, with a final report for the 2024 data year; the law itself is unchanged.

Medicare and Death with Dignity

Medicare does not pay for medication prescribed under the Death with Dignity Act. The federal Assisted Suicide Funding Restriction Act of 1997 bars federal health programs, including Medicare, Medicaid's federal share and the VA, from paying for items or services provided to cause a patient's death. Patients usually pay for the medication themselves.

Using the Washington law does not end your Medicare coverage. People who use it may continue to receive hospice and other Medicare-covered care.

Advance directives

Advance directives let you put your wishes in writing before a crisis. Washington's main documents are:

Health care directive (living will): your wishes about life-sustaining treatment (chapter 70.122 RCW)
Durable power of attorney for health care: names someone to make health care decisions if you can't (chapter 11.125 RCW)
POLST (Portable Orders for Life-Sustaining Treatment): medical orders signed by your physician, physician assistant or nurse practitioner that say which life-sustaining treatments you want in an emergency. POLST is designed for people who are seriously ill or in very poor health.

Ask your health care provider for these forms. The Washington State Medical Association publishes the Washington POLST form and how to order it. Medicare covers advance care planning as part of your yearly wellness visit and as a separate service.

Long-term care planning

Beyond end-of-life care, late-life planning often includes:

Apple Health long-term services and supports for nursing facility or in-home care
The WA Cares Fund, a first layer of long-term care funding for workers who qualify
Private long-term care insurance
Family conversations and planning documents

Community Living Connections (1-855-567-0252) can connect you with local long-term care services and supports anywhere in the state. For questions about how your Medicare plan covers hospice and other care, a licensed insurance agent with Benefits Life can help at no cost to you: call (206) SENIORS (206-736-4677), TTY 711.

Resources

Medicare: 1-800-MEDICARE (1-800-633-4227), for questions about hospice coverage
Washington State Department of Health: Death with Dignity Act information and forms
End of Life Washington: a nonprofit that supports people considering the law and other end-of-life options, 206-256-1636
Community Living Connections: 1-855-567-0252

Sources

Frequently asked questions

Does Medicare cover hospice care?

Yes. Medicare Part A covers hospice when your hospice doctor (and your regular doctor, if you have one) certify a life expectancy of six months or less and you choose comfort care instead of treatment to cure the illness. You pay nothing for covered hospice care, except a small copayment for each outpatient prescription for pain and symptom control and 5% of the Medicare-approved amount for inpatient respite care.

Does Medicare pay for medication under Washington's Death with Dignity Act?

No. The federal Assisted Suicide Funding Restriction Act of 1997 bars federal programs, including Medicare, from paying for items or services meant to cause a patient's death. Medicare still covers hospice and other care for people who use the Washington law.

Can I leave hospice if I change my mind?

Yes. You can stop hospice at any time and go back to Medicare coverage for treatment of your illness. If you qualify, you can elect hospice again later.

What if I live longer than six months on hospice?

Hospice under Medicare is given in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. You can keep getting hospice as long as the hospice doctor recertifies, after a face-to-face visit, that you remain terminally ill.

Where do I get POLST and advance directive forms in Washington?

Ask your doctor or other health care provider. The Washington State Medical Association publishes the Washington POLST form and explains how to order it, and many Washington providers can help you complete a health care directive and a durable power of attorney for health care.

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Licensed insurance agents for Washington

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