Free tool · Hospice
Hospice Cap Calculator
Estimate your Medicare aggregate cap, see any overpayment or headroom, and check the 20 percent inpatient day limit. Free, with no signup.
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The calculator
Estimate your hospice cap position
Two checks in one place: the aggregate cap (payments against a per-beneficiary ceiling) and the inpatient day limit. Everything runs in your browser. Nothing you enter is saved or sent.
Your result
Choose a cap year, enter your beneficiary count and total payments, then select Estimate aggregate cap.
Your result
Enter your inpatient days and total hospice days, then select Check inpatient limit.
Want a CPA to run your actual cap calculation?
These are estimates from numbers you type in. Your MAC makes the final determination. Book a free 20-minute call.
The rule
How the hospice cap works
Medicare limits what a hospice can be paid in a cap year. Your aggregate cap is the per-beneficiary cap amount multiplied by the number of Medicare beneficiaries counted for that year (42 CFR 418.309). The cap year runs October 1 to September 30. For FY 2027 (October 1, 2026 to September 30, 2027) the cap amount is $36,174.75. For FY 2026 it is $35,361.44. Payments above the cap are overpayments and must be refunded (42 CFR 418.308(d)).
The beneficiary count comes from one of two methods. The streamlined method counts beneficiaries who elected hospice during the cap period and were not counted in an earlier cap. The patient-by-patient proportional method counts only the share of each patient's hospice days that fall in your cap year. This calculator does not work out the count. You enter it.
The deadline
When is the hospice cap filed?
Your hospice files its own self-determined aggregate cap determination with its Medicare Administrative Contractor (MAC) no later than 5 months after the cap year ends, and remits any overpayment at that time (42 CFR 418.308(c)). For the FY 2026 cap year ending September 30, 2026, that is February 28, 2027. For FY 2027 it is February 29, 2028. Confirm the date with your MAC.
The cap is a separate filing from the Medicare cost report, with its own due date. If the cap is not filed on time, Medicare payments to the hospice can be suspended in whole or in part until it is filed (42 CFR 405.371(e)). Use the cost report due date calculator to see both dates.
The second cap
What is the inpatient 20 percent limit?
Total inpatient care days (general inpatient and inpatient respite) for Medicare patients may not exceed 20 percent of the total days those patients elected hospice care (42 CFR 418.302(f)). At the end of the cap period, your MAC calculates the limit.
If inpatient days go over 20 percent, payment for the excess days is figured at the routine home care rate, and any excess reimbursement must be refunded. Only days provided and billed as general inpatient or respite count as inpatient days.
Limits of an estimate
What this calculator does not do
It does not count beneficiaries, apply the proportional method, adjust for transfers, or price the inpatient refund. Your MAC makes the final determination and can reopen it. Use the result as a planning check, then confirm with your own cap workpapers or a CPA. For background, read the hospice aggregate cap explained, or see how the cap fits next to hospice cost report preparation and hospice accounting services.
Where the rules come from (checked October 2026)
Sources and disclaimer
- 42 CFR 418.309, hospice aggregate cap (streamlined and proportional methods)
- 42 CFR 418.308, limitation on hospice payments (self-determined cap filing, overpayments)
- 42 CFR 418.302, payment procedures (inpatient day limitation in paragraph (f))
- 42 CFR 418.3, definition of the cap period
- 42 CFR 405.371, suspension of payment
- CMS FY 2027 hospice final rule fact sheet (CMS-1851-F): FY 2027 cap amount $36,174.75
This calculator provides general information and an estimate, not tax, legal or reimbursement advice. It does not replace the current CMS rules or your MAC's determination. Nothing you enter is stored or sent.
What happens next
- 01
Free 20-minute call
Tell Christian about your agency and what is on your plate. No pitch deck, no pressure.
- 02
Written fee quote
You get a clear written quote for the work before we start. No surprises.
- 03
We handle it
Your CPA team takes it from there and keeps you posted until it is filed.
FAQ
Hospice cap calculator questions, answered
Still have questions? Ask them on a free 20-minute call.
What is the hospice aggregate cap?
It is a limit on total Medicare payments to a hospice in a cap year. The aggregate cap is the per-beneficiary cap amount multiplied by the number of Medicare beneficiaries counted for the year (42 CFR 418.309). Payments above it are overpayments that must be refunded.
What is the FY 2027 hospice cap amount?
$36,174.75 per beneficiary, according to CMS's fact sheet on the FY 2027 hospice final rule (CMS-1851-F). It applies to the cap year October 1, 2026 to September 30, 2027. The FY 2026 amount is $35,361.44.
What is the hospice cap year?
October 1 to September 30, the twelve-month period ending September 30 (42 CFR 418.3). The older November 1 to October 31 cap year no longer applies.
How do I get my beneficiary count?
From your cap workpapers, using either the streamlined method or the patient-by-patient proportional method (42 CFR 418.309). Under the streamlined method you count beneficiaries not previously counted in a cap. Under the proportional method you count only the fraction of each patient's hospice days in your hospice during the cap year. This calculator takes the count as an input.
Which payments count toward the cap?
Enter the total Medicare hospice payments for services furnished in the cap year. Your MAC applies the final payment figures and any adjustments, so use your best records and treat the result as an estimate.
When is the hospice cap filing due?
No later than 5 months after the cap year ends (42 CFR 418.308(c)). For the cap year ending September 30, 2026 that is February 28, 2027. Confirm the date with your MAC.
Is the hospice cap part of the cost report?
No. The cap is a separate filing with its own due date. Your hospice determines its own cap and files it with the MAC, then the MAC issues its final determination. Use the cost report due date calculator to see both deadlines.
What happens if I exceed the cap?
Payments above the cap are overpayments and must be refunded (42 CFR 418.308(d)). The self-determined filing requires you to remit any overpayment due at the time you file.
What is the inpatient 20 percent limit?
It is the inpatient day limitation in 42 CFR 418.302(f). Total inpatient days (general inpatient and respite) for Medicare patients may not exceed 20 percent of the total days those patients elected hospice care. If you are over, the payment for the excess days is figured at the routine home care rate, and any excess reimbursement must be refunded.
Which days count as inpatient days?
Only days provided and billed as general inpatient or inpatient respite care (42 CFR 418.302(f)(2)). Routine home care and continuous home care days count in your total hospice days but not as inpatient days.
Does this calculator figure my refund for excess inpatient days?
No. It shows your inpatient share and how many days are over the limit. The refund depends on your inpatient payments and the routine home care rate, so your MAC calculates it.
Can you run my actual cap calculation?
Yes. Book a free 20-minute call and we will look at your cap position. Our flat-fee cost report ($1,599.99, see pricing) covers the cost report; cap review is a separate service.
Free 20-minute call
Want a CPA to run your actual cap calculation?
Talk directly with Christian Soriaga, CPA. No pitch deck, no obligation.
On the call we’ll cover
- Your situation and what is due next
- Deadlines and filing status
- A clear written fee quote
- Clear next steps, no obligation
Christian Soriaga, CPA
Soriaga & Associates, LLC