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Coverage of hospice care depends upon a physician's certification that an individual's life expectancy is six months or less, given the normal course of the disease. 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.

If a patient meets the medical criteria, they are, by definition, eligible to receive hospice services. However, some patients may not meet the criteria, but may still be eligible for hospice care because of other co-morbidities or rapid functional decline.

Hospice Advantage is dedicated to providing hospice care to every person eligible for hospice services, regardless of their age, diagnosis or ability to pay. The Medicare criteria for hospice guide is designed to assist physicians in determining hospice appropriateness.