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KeptWell research · Medicare data, August 2026

Why do half of hospices have no ratings on Care Compare?

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KeptWell's analysis of Medicare's August 2026 hospice data found that 3,465 of 6,669 US hospices (52%) have no family-caregiver ratings on Care Compare, including 1,107 of 1,160 hospices in Los Angeles County (95%). Most are too new or too small to be surveyed. Together they cared for about 11% of hospice patients on an average day in 2024.

So a blank rating isn't proof of bad care. It means the one part of Care Compare that tells you what other families went through can't help you choose that hospice. Below: where the gap is, why it's there, and what to check instead.

What this page covers

  1. 01How many hospices have no family ratings?
  2. 02Which states have the most hospices with no ratings?
  3. 03Why are newer hospices the ones with no ratings?
  4. 04Are for-profit hospices more likely to have no ratings?
  5. 05How many patients are in hospices with no ratings?

What do hospice ratings on Care Compare measure?

The ratings come from the CAHPS Hospice Survey, which goes to the family caregivers of patients who died in a hospice's care. It asks whether the patient got help for pain and symptoms, whether help came on time, whether the team communicated well and treated the patient with respect, whether the family got emotional and spiritual support, how they'd rate the hospice from 0 to 10, and whether they'd recommend it. Care Compare shows the answers as percentages, and rolls them into a star rating once a hospice has at least 75 completed surveys.

It's the closest thing to asking a hundred families how it went, and KFF Health News tells readers to "choose a highly rated hospice" on Care Compare. Where scores exist, they give you a yardstick. Across the US, 83% of families rated their hospice 9 or 10, 85% would definitely recommend it, and 9% said the patient only sometimes or never got the help they needed for pain and symptoms. A hospice well below those numbers is worth asking about.

The trouble is how many hospices have no numbers at all.

What you'll find here

The numbers come from Medicare's own files, the same data Care Compare shows. No hospice is named.

  • How many hospices have no family ratings, and the reason Medicare gives for each.
  • Where they are: a map by state, and Los Angeles County.
  • Why newer hospices are the gap, and how ownership lines up with it.
  • What to check when the hospice you are looking at has no ratings.

Where are the hospices with no ratings, and why?

Medicare's August 2026 files list 6,669 hospices. Here's what the family survey shows for them.

How many hospices have no family ratings?

Of the 6,669 hospices in Medicare's August 2026 data, 3,465 have no score on any family-caregiver measure. Medicare marks each blank with a reason. For 3,223 of them, the hospice is too new or too small to be required to take part: a hospice that served fewer than 50 survey-eligible patients in the year before can be excused, and so can one certified during the survey year. Another 225 took part but didn't get enough completed surveys for a score, and 17 sent no data.

More have no star rating: 4,505 hospices (68%), because a hospice can have a few scores and still fall short of the 75 surveys a star rating needs. No hospice has a star rating without scores.

Which states have the most hospices with no ratings?

The gap isn't spread evenly. In California, 1,622 of 1,913 hospices (85%) have no family scores, and in Los Angeles County it's 1,107 of 1,160 (95%). Only 53 hospices in the county have any family scores, and 24 have a star rating. Nevada is at 85% (155 of 183), Texas at 68% (715 of 1,053) and Arizona at 58% (138 of 237). Utah and Alaska are at 50%, Colorado 44%, Georgia 43%, New Mexico 42% and Washington, DC 40%.

In most of the country it looks very different. Almost every other state sits between 10% and 35%, and Maine (6%) and Maryland (8%) are lower. Florida has 8 unrated hospices out of 61 (13%), New York 1 out of 39, and Hawaii, Kentucky, Vermont and West Virginia have none. A family in New York can compare almost every hospice by its ratings. A family in Los Angeles County almost never can.

Every state and territory, with counts, is in the full table as a CSV file.

Share of hospices with no family ratings, by state

n = 6,621 hospices in 50 states and DC · August 2026

Each tile is one state, whatever its size. Puerto Rico, Guam, the US Virgin Islands and the Northern Mariana Islands are in the CSV.

Share of each state's Medicare hospices with no family-caregiver scores on Care Compare. Source: CMS Provider CAHPS Hospice Survey Data, August 2026 (surveys from October 2023 to September 2025). Analysis: KeptWell, November 3, 2026.

Why are newer hospices the ones with no ratings?

Because the survey takes time to build up. Among hospices certified by Medicare before 2010, 14% have no family scores. For those certified between 2010 and 2014 it's 41%, and between 2015 and 2019 it's 59%. Then it jumps: 75% for 2020, 85% for 2021, 86% for 2022 and 2023, and 93% for 2024. Of the 193 hospices certified in 2025, 192 (99%) have none.

That's the survey working as designed. A new hospice is excused in its first year, a small one each year it stays small, and a score needs enough families to answer over two years. But it means the hospices with the least track record are exactly the ones Care Compare can't tell you about. And there are a lot of new ones: 1,409 of the hospices listed today were certified in 2021 or 2022 alone.

Share of hospices with no family ratings, by year certified

n = 6,668 hospices · August 2026

Number under each bar: hospices certified in those years.

Share of hospices with no family-caregiver scores, by the year Medicare certified them, with the number of hospices under each year. One hospice certified in 2026 is left out. Sources: CMS Provider CAHPS Hospice Survey Data and Hospice General Information, August 2026. Analysis: KeptWell, November 3, 2026.

Are for-profit hospices more likely to have no ratings?

Yes, by a wide margin. 48% of for-profit hospices (1,822 of 3,775) have no family scores, against 9% of nonprofits (79 of 837). Government-run hospices sit at 35% (38 of 109) and other ownership types at 25% (96 of 388).

The biggest group is the one Medicare lists with no ownership type at all: 1,560 hospices, every one certified in 2019 or later, and 1,430 of them (92%) with no family scores. Ownership and age overlap here, so this isn't a verdict on for-profit care. It does tell you that when the hospice you're looking at is new and its ownership is blank, you're very unlikely to find family ratings for it.

Share of hospices with no family ratings, by ownership

n = 6,669 hospices · August 2026

Number under each bar: hospices of that ownership type.

Share of hospices with no family-caregiver scores, by ownership type, with the number of hospices under each type. Government includes combined government and nonprofit. Sources: CMS Provider CAHPS Hospice Survey Data and Hospice General Information, August 2026. Analysis: KeptWell, November 3, 2026.

How many patients are in hospices with no ratings?

Far fewer than the hospice count suggests. The unrated hospices are mostly small. On an average day in 2024 they cared for about 40,400 of the 370,400 patients in hospice care, or 11%. Most hospice patients, 89% on an average day, are in a hospice that does have family ratings.

You feel the gap when you're the one choosing. Search Care Compare by ZIP code and the unrated hospices sit in the same list as the rated ones. In much of California, Nevada and Texas, most of that list has nothing from other families beside it.

What can you check when a hospice has no ratings?

A blank rating means you'll have to ask for what the survey would have told you. Five things help:

  1. Look at the rest of its Care Compare page. Medicare also shows quality measures built from Medicare claims, including the Hospice Care Index, and those don't depend on families answering a survey. Of the 3,465 hospices with no family scores, 2,082 (60%) have a Hospice Care Index score.
  2. Ask when it was certified by Medicare, and who owns it. A hospice certified in the last few years almost never has family ratings yet, so you'll be relying on what it tells you and what you can check.
  3. Ask the questions the survey asks. Who comes at 2 a.m. when pain gets worse, and how fast? How often will a nurse visit? Who do we call, and who answers? Our questions to ask a hospice puts them on one page you can take to the first meeting.
  4. Ask the people who see hospices at work: the hospital discharge planner or social worker, your doctor, and families you know who have used one. Ask which hospices answer the phone at night.
  5. Compare with a rated hospice nearby. If one hospice in your area has scores, use it as a yardstick: ask the unrated one the same questions and see how its answers hold up.

Will Medicare's enrollment pause change the list?

Not for anyone choosing a hospice this winter. On May 13, 2026, Medicare paused new enrollment of hospices and home health agencies nationwide for six months. That doesn't change who's on Care Compare today, and for half of that list, the family ratings will still be blank.

If someone you love is moving to hospice, what hospice does not do explains what the benefit covers at home, and how to qualify for hospice explains the rules for getting in.

How KeptWell did this analysis

KeptWell downloaded four Medicare files on November 3, 2026, all from the August 2026 Care Compare refresh: Provider CAHPS Hospice Survey Data (surveys from October 1, 2023 to September 30, 2025), Hospice General Information (certification date and ownership), Hospice Provider Data (average daily census for 2024, reported by 5,979 hospices) and National CAHPS Hospice Survey Data. The files were joined on each hospice's CMS Certification Number. All 6,669 hospices matched.

A hospice counts as having no family scores when none of the 21 family-caregiver measures has a number. The reasons come from Medicare's footnotes on those rows: too new or too small to be required to take part (3,223), too few completed surveys (225), no data sent (17). KeptWell also counted hospices with no summary star rating: 4,505. Los Angeles County means hospices whose listed county is Los Angeles. Territories are in the national count.

KeptWell will update these numbers with each quarterly Care Compare refresh. To cite this page: KeptWell, "Why do half of hospices have no ratings on Care Compare?", November 3, 2026, https://keptwell.org/guides/hospices-without-family-ratings.

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Common questions about hospice ratings

Where can I see a hospice's ratings?
On Medicare's Care Compare site, at medicare.gov/care-compare. Search for hospices near you and open one to see its family-caregiver survey results, its star rating if it has one, and the quality measures Medicare builds from claims, such as the Hospice Care Index.
Is a hospice with no star rating a bad hospice?
Not on that evidence alone. Most hospices with no ratings are too new or too small for the survey to be required, or haven't had enough families answer it yet. A blank rating means you can't learn what other families thought from Care Compare, so ask the hospice directly and check the measures that don't depend on the survey.

Related guides

Keep the hospice's paperwork where the whole family can read it

Hospice comes with an admission packet, a care plan and a new medication list, all in the first few days. Upload them and KeptWell reads each one, dates it, and explains it in plain English, with the source line cited. Everyone in your circle reads the same explanation. Free today.

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