Hospice Enrollment Climbs Nationwide

The number of Medicare beneficiaries receiving hospice care increased again in 2024, according to the latest “Facts and Figures” report from the National Alliance for Care at Home.

The report found that 1.91 million Medicare beneficiaries received hospice services for at least one day in calendar year 2024, representing a 4.4% increase over 2023. The annual report examines trends in hospice patient demographics, provider characteristics, quality measures, care settings, and Medicare spending.

For more than two decades, the report has served as a key data resource for policymakers, providers, and researchers tracking the evolution of hospice and end-of-life care in the United States.

The 2025 edition includes expanded and more current data sources through a collaboration with the Research Institute for Home Care, which partnered with the Alliance to strengthen the report’s data analysis.

More Americans Dying in Hospice Care

The data also show that hospice continues to play a growing role in end-of-life care.

In 2024, about 1.3 million Medicare beneficiaries died while receiving hospice services, representing 53.1% of all Medicare decedents. That figure marks the highest share on record and exceeds levels seen before the COVID-19 pandemic.

Researchers say the numbers suggest that hospice utilization is continuing its return to pre-pandemic patterns as federal payment and regulatory policies have moved out of emergency pandemic frameworks.

Medicare Advantage and Hospice Coverage

The report also highlights ongoing complexities surrounding hospice coverage for Medicare Advantage beneficiaries.

While enrollment in Medicare Advantage plans continues to grow, hospice care is still largely administered through the traditional Medicare hospice benefit. Beneficiaries enrolled in Medicare Advantage generally transition back to traditional Medicare when they elect hospice.

A federal demonstration program that ran from 2021 through 2024 explored whether Medicare Advantage plans could directly cover hospice services. The initiative was ended early, however, due to low participation and operational challenges.

Persistent Racial Disparities in Hospice Use

Despite overall growth, the report underscores continuing disparities in hospice utilization among racial and ethnic groups.

In 2024:

• 55.8% of white Medicare decedents used hospice care
• 41.2% of Hispanic beneficiaries received hospice services
• 40.5% of Black beneficiaries enrolled in hospice
• 40.2% of American Indian and Alaska Native beneficiaries used hospice
• 39.4% of Asian American beneficiaries accessed hospice care

While utilization rates among all groups have recovered to or exceeded pre-pandemic levels, the data indicate that minority populations remain less likely to receive hospice services before death.

Conditions Leading to Hospice Care

The report also analyzes the most common clinical conditions leading patients to hospice care.

The largest share of hospice stays in 2024 involved circulatory conditions (29.8%), followed by:

• Neurovascular conditions: 25.4%
• Cancer: 22.3%
• Respiratory conditions: 10.1%
• Kidney disease: 3.0%

Together, these five diagnostic categories account for more than 90% of hospice admissions.

Medicare Spending on Hospice Reaches $28 Billion

Medicare spending on hospice services also rose significantly.

In 2024, Medicare paid hospice providers $28.2 billion, a 10.1% increase from the previous year. Analysts attribute the growth to both rising hospice enrollment and routine annual payment updates.

The report also includes a special section examining quality reporting and measurement in the hospice payment system, reflecting ongoing efforts to evaluate outcomes and improve accountability across hospice providers.

A Key Resource for the Hospice Community

Jennifer Sheets, CEO of the National Alliance for Care at Home and president of the Research Institute for Home Care, said the report continues to serve as a foundational resource for the industry.

The updated report, she noted, introduces new data sources and expanded analysis designed to give providers and policymakers a clearer understanding of how hospice services are evolving nationwide.