Key Takeaways
- Medicare covers hospice care under Part A, with no deductible for the hospice benefit itself.
- Covered: nursing and physician visits, home health aide services, medications for symptom management, equipment, supplies, therapies, counseling, chaplain support, respite, and bereavement care.
- You may pay up to $5 per prescription for symptom-management drugs and 5% coinsurance for inpatient respite care, capped at the Part A inpatient deductible.
- Not covered: curative treatment for the terminal illness, room and board in a facility, and care your hospice did not arrange.
- Coverage runs in two 90-day benefit periods followed by unlimited 60-day periods — there is no lifetime cap.
- Patients can revoke hospice at any time and re-elect it later, and may change hospice providers once per benefit period.
- Michigan Medicaid, VA benefits, and most private plans offer comparable hospice coverage.
Disclaimer: This article is for informational purposes only. Every patient’s condition and care needs are unique. Please consult a licensed healthcare professional for advice specific to your loved one’s situation. Choice Hospice’s clinical team is also available to answer your questions and guide your family through this process.
The Question Almost Every Family Asks First
Before anyone asks what hospice does, they ask what it costs. It is a fair question and it is usually asked apologetically, as if worrying about money at a time like this were somehow shameful. It isn’t. Families across Southeast Michigan are already carrying medical bills, lost work hours, and the cost of a house that suddenly needs a ramp and a hospital bed.
So here is the direct answer: Medicare covers hospice care almost entirely, and for most families the out-of-pocket cost is close to nothing.
Below is exactly what that means.
Does Medicare Cover Hospice? Yes — Under Part A
The Medicare hospice benefit sits under Part A, the same part that covers hospital stays. There is no deductible for hospice care itself. Medicare pays the hospice provider directly for the care, the visits, the equipment, and the medications tied to the terminal illness.
The benefit is comprehensive by design. Congress built it that way specifically so that no family would have to choose between comfort and solvency at the end of a life.
One requirement matters above all others: the hospice agency must be Medicare-certified. Care from a provider that is not certified is not covered. Any legitimate hospice will confirm its certification immediately if you ask.
Who Qualifies
Three conditions must be met.
- The patient is enrolled in Medicare Part A
- A hospice physician and the patient’s own doctor both certify a terminal illness with a prognosis of six months or less if the illness follows its expected course
- The patient signs an election statement choosing comfort-focused care over treatment intended to cure the terminal illness
Notably, the diagnosis does not have to be cancer. Heart failure, COPD, dementia, kidney failure, Parkinson’s, ALS, and stroke are all common qualifying conditions.
What Medicare Pays For
Once the benefit is elected, Medicare covers everything below as it relates to the terminal illness.
- Visits from the hospice nurse and the hospice physician
- Home health aide and homemaker services for bathing, dressing, and personal care
- Medications for pain and symptom management
- Durable medical equipment — hospital bed, wheelchair, oxygen, walker, bedside commode
- Medical supplies such as gloves, dressings, and briefs
- Physical, occupational, and speech therapy when they support comfort or function
- Dietary counseling
- Medical social worker services
- Spiritual and chaplain support
- Short-term inpatient hospice care for symptoms that cannot be managed at home
- Inpatient respite care so family caregivers can rest
- Grief and bereavement services for the family for up to 13 months after the death
Families are often surprised by the equipment. The bed, the oxygen concentrator, the wheelchair — delivered, set up, maintained, and picked up afterward, at no charge. For families managing end of life care at home, that alone removes thousands of dollars of expense and a great deal of logistics.
What You May Still Pay
The cost-sharing under the hospice benefit is deliberately small. There are two items.
Prescription copay. A copayment of up to $5 per prescription may apply to outpatient drugs for pain and symptom management. Many hospice providers absorb this rather than bill for it. If a specific drug is not covered under the hospice benefit, the provider should check whether the patient’s Part D plan covers it.
Respite coinsurance. If your loved one uses inpatient respite care, you may owe 5% of the Medicare-approved amount for those days. That copayment cannot exceed the Part A inpatient hospital deductible for the year.
That is the entire list. There is no per-visit charge, no charge for the nurse, no charge for equipment, and no annual maximum on hospice services.
What Medicare Does Not Cover
Four things fall outside the benefit, and knowing them in advance prevents unpleasant surprises.
Treatment intended to cure the terminal illness. Once hospice is elected, curative treatment for that illness is no longer covered under the benefit.
Room and board. This is the one that catches families off guard. If the patient lives in a nursing home, an assisted living community, or a memory care residence, the hospice benefit covers the hospice care delivered there — but not the rent, the meals, or the facility’s own care charges. Anyone researching medicare assisted living coverage runs into this same wall: Medicare does not pay for a residence. Those costs continue to be billed separately, though Medicaid, long-term care insurance, or VA benefits may help.
Care from a provider your hospice did not arrange. If you seek care elsewhere without coordinating through your hospice team, you may be responsible for the full amount. Emergency care always remains available, but call the hospice first — that 24-hour line exists exactly for this.
Care unrelated to the terminal illness is still covered, but under regular Medicare Parts A and B, meaning normal deductibles and coinsurance apply. A hospice patient who breaks a wrist still has that treated under standard Medicare.
How Long Coverage Lasts
There is no lifetime limit. Coverage runs in benefit periods: two 90-day periods, followed by an unlimited number of 60-day periods, as long as the patient continues to meet clinical criteria. A face-to-face recertification visit is required after the second 90-day period and before each period after that.
So long term hospice care is entirely possible under Medicare. Patients who live well past six months and still qualify keep their coverage.
The benefit is also reversible. A patient can revoke hospice at any time, for any reason, and standard Medicare coverage for the illness resumes immediately. If the situation changes later, they can elect hospice again. Patients may also switch to a different hospice agency once per benefit period.
What About Medicaid, the VA, and Private Insurance?
Michigan Medicaid offers a hospice benefit that closely mirrors Medicare’s, and for patients who are dually eligible, Medicaid may also cover nursing facility room and board that Medicare does not.
The VA covers hospice as part of its standard medical benefits package for enrolled veterans, generally with no copay for the hospice care itself.
Most private insurers and Medicare Advantage plans include a hospice benefit modeled on Medicare’s. If you are working through home health care service insurance questions or comparing an Advantage plan’s terms, your hospice’s admissions team will verify benefits before care begins — free, and usually within a day.
How to Get Started
Call a Medicare-certified hospice near you and ask for an informational visit. Nothing is signed at that meeting.
Have on hand: the Medicare card, any supplemental or Advantage plan information, a current medication list, and the name and phone number of the primary physician. If advance directives or a power of attorney exist, bring those too. If they don’t, the medical social worker can help you get them in place.
The hospice verifies coverage, confirms eligibility with the physicians, and explains in writing what is covered and what is not before care begins. You should never have to guess.
Have Questions About Coverage? Ask Your Local Team
Our admissions coordinators verify Medicare, Medicaid, VA, and private insurance benefits at no cost and will walk you through exactly what your family would and would not pay. Reach out to your local Choice Hospice branch — we are right here in Southeast Michigan.
Helpful next steps: See our hospice services | Resources for families
Choice Hospice — serving West Bloomfield, Sterling Heights, Troy, Warren, Oakland Township, Roseville, and the surrounding communities of Southeast Michigan. Reach out to your local branch anytime. We are always close by.