Yes. If your loved one has Medicare Part A, hospice care is covered in Michigan just as it is everywhere in the country, and for most families the out-of-pocket cost is close to zero. Medicare pays the hospice directly for nursing visits, aide care, medications for the terminal illness, equipment, supplies, social work, chaplain support, and bereavement care. The two possible charges are small: up to $5 per prescription for symptom-control drugs, and 5% of the Medicare-approved amount for short inpatient respite stays. What Medicare does not cover is also important to know, and we cover that below.
What the Medicare hospice benefit is
The Medicare hospice benefit is part of Medicare Part A, the hospital insurance most people get at 65. It was designed so a person with a terminal illness could receive comfort-focused care, usually at home, without the family going broke.
To use the benefit, three things have to be true:
- A physician certifies that your loved one likely has six months or less to live if the illness runs its normal course. The hospice medical director participates in this certification along with the patient’s own doctor, if they have one.
- Your loved one accepts comfort care instead of treatment intended to cure the terminal illness.
- Your loved one signs a statement electing hospice with a Medicare-certified hospice.
Once elected, the hospice becomes responsible for nearly everything related to the terminal illness. Medicare pays the hospice a daily rate, and the hospice arranges and pays for the care.
Benefit periods
Hospice is not limited to six months. Medicare covers two 90-day benefit periods, followed by unlimited 60-day periods. At the start of each, the hospice physician recertifies that the person still qualifies. People who stabilize may be discharged and can re-enroll later. Your loved one can also revoke hospice at any time and return to regular Medicare coverage.
What Medicare hospice covers
Everything on this list is covered when it is related to the terminal illness and part of the hospice plan of care:
- Physician services, including the hospice medical director and your loved one’s own attending physician
- Nursing care, with regular visits and 24-hour phone access to a nurse
- Hospice aide services for bathing, dressing, and personal care
- Medical social services
- Spiritual and grief counseling for the patient and family
- Prescription drugs for pain and symptom control
- Medical equipment such as a hospital bed, wheelchair, walker, oxygen, or bedside commode
- Medical supplies such as incontinence products, wound dressings, and gloves
- Physical, occupational, speech, and dietary services when they serve comfort
- Short-term inpatient care for symptom crises and
short-term respite care so the caregiver can rest - Bereavement support for the family, for up to a year after the death
You do not pay for the hospice bed, the oxygen, the morphine, or the nurse’s visit. Medicare pays the hospice, and the hospice provides these as part of the plan of care.
The four levels of hospice care
Every Medicare-certified hospice must be able to provide four levels of care. Knowing them helps you understand what to expect and what to ask for.
1. Routine home care
This is what most patients receive most of the time. The hospice team visits wherever your loved one lives: a house in Farmington Hills, an assisted living apartment, a memory care unit, or a nursing home. Family members or facility staff provide the hands-on care between visits.
2. Continuous home care
When symptoms become severe, such as uncontrolled pain, agitation, or breathing distress, a hospice can provide nursing care at home for extended hours during a crisis, so the person can stay home instead of going to the hospital. Medicare requires this care to be predominantly nursing, for at least 8 hours in a 24-hour day, for short periods until symptoms are controlled.
3. Inpatient respite care
Respite care lets your loved one stay in a Medicare-approved facility, such as a hospice inpatient unit, hospital, or nursing home, for up to 5 consecutive days per occurrence so you can rest. This is the one level where a coinsurance applies: you may owe 5% of the Medicare-approved amount for the stay.
4. General inpatient care
When symptoms cannot be managed at home, hospice can arrange a short stay in a hospital, inpatient hospice unit, or skilled nursing facility with round-the-clock nursing. This is for acute symptom management, not long-term placement.
You can read more about how families decide between home and facility care in Hospice at Home or in a Facility?.
What you might pay
The Medicare hospice benefit has no deductible. Here is the complete list of possible costs under Original Medicare:
| Item | What you may pay |
|---|---|
| Nursing, aide, social work, chaplain, equipment, supplies | $0 |
| Prescription drugs for pain and symptom management | Up to $5 per prescription |
| Inpatient respite care | 5% of the Medicare-approved amount |
| Continuous home care and general inpatient care | $0 |
| Bereavement support | $0 |
Medicare allows a hospice to charge up to $5 per prescription for outpatient drugs used for pain and symptom management. Ask the hospice you are considering whether it bills that copay.
What Medicare hospice does not cover
This is where families get surprised, so read carefully.
Room and board in a facility
If your mother lives in a nursing home or assisted living,
Medicare hospice does not pay for her room and board there. It covers the hospice services delivered to her in that setting. The monthly cost of the facility stays what it was, paid by her, by long-term care insurance, or by Medicaid if she qualifies. The exceptions are short respite and general inpatient stays arranged by the hospice, which are covered.
Treatment intended to cure the terminal illness
When your loved one elects hospice, Medicare stops paying for treatment meant to cure the terminal illness. Some treatments that are primarily for comfort, such as radiation to shrink a painful tumor, may be included in the plan of care. Ask the hospice physician. Your loved one can revoke hospice at any time to pursue curative treatment again.
Care from providers the hospice did not arrange
Once on hospice, care for the terminal illness must come from the hospice or be arranged by it. If your father goes to the ER for a problem related to his illness without the hospice involved, Medicare may not cover that visit. Always call the hospice first.
Conditions unrelated to the terminal illness
Medicare continues to cover care for unrelated conditions under regular Part A and Part B. Your loved one can keep seeing their own doctors for those. The hospice team can help sort out what is related and what is not.
Medicaid, Medicare Advantage, VA, and private insurance
Michigan Medicaid
Michigan Medicaid includes a hospice benefit that mirrors Medicare’s. If your loved one has both, Medicare pays for hospice services and Medicaid may cover nursing facility room and board. The hospice social worker can help coordinate.
Medicare Advantage plans
This confuses a lot of families. If your loved one has a Medicare Advantage plan, hospice is still covered by Original Medicare, not the Advantage plan. Original Medicare pays the hospice directly. The Advantage plan keeps covering anything unrelated to the terminal illness. Your loved one does not need to leave the plan, and the plan’s network does not limit which Medicare-certified hospice they choose.
VA benefits
Veterans enrolled in VA health care are eligible for hospice through the VA, at a VA facility or through community hospices the VA authorizes. Most veterans also have Medicare, which can pay for hospice directly. If your loved one is a veteran, mention it when you call. See our Veterans page.
Private insurance and employer plans
Most private plans include a hospice benefit modeled on Medicare’s. Details vary, and some plans use networks. The hospice will verify benefits before care starts.
How Lily handles this
Lily Hospice is Medicare-certified and ACHC-accredited, and provides all four levels of care. When you call, we verify your loved one’s coverage, whether Original Medicare, Medicare Advantage, Michigan Medicaid, VA, or a private plan, and explain in plain terms what is covered before anything begins. We provide equipment, supplies, and medications related to the terminal illness as part of the plan of care. If something would fall outside the benefit, we tell you before it happens, not after.
Frequently asked questions
Is there a deductible or copay for Medicare hospice? No deductible. The only possible costs are up to $5 per prescription for symptom-control drugs and 5% of the Medicare-approved amount for inpatient respite care. Everything else related to the terminal illness is paid by Medicare.
Does Medicare hospice pay for a nursing home? No. It pays for hospice services delivered in the nursing home, not for room and board. Medicaid may cover room and board for those who qualify.
Can my dad keep his Medicare Advantage plan on hospice? Yes. Hospice is paid by Original Medicare regardless of the Advantage plan. He keeps his plan for unrelated care.
Can we leave hospice if we change our minds? Yes. Your loved one can revoke hospice at any time and return to regular Medicare coverage, including curative treatment. They can re-elect hospice later.
Talk to us
Insurance questions should not stand between your family and good care. Call Lily Hospice at (248) 955-5100 and we will check your loved one’s coverage and answer your questions honestly, any time of day or night. Or reach us online.
Written and reviewed by the Lily Hospice clinical team.
Sources
- Medicare.gov, “Hospice care”: https://www.medicare.gov/coverage/hospice-care
- Medicare.gov, “Medicare Hospice Benefits” (official booklet, CMS Product No. 02154): https://www.medicare.gov/publications/02154-medicare-hospice-benefits.pdf
- CMS, Hospice Center: https://www.cms.gov/medicare/payment/hospice
- Michigan Department of Health and Human Services, Medicaid provider information on hospice: https://www.michigan.gov/mdhhs
