Hospice Pricing and Who Pays for Hospice Care in Michigan
Hospice doesn't come with a price tag the way most services do, and that confuses a lot of families. Once you see how it's paid for, the costs get much easier to predict. This page explains the pricing structure, who pays, what you may still owe, and what hospice doesn't cover.
The short answer
For most families, the hospice care itself costs little or nothing out of pocket. Medicare pays for hospice care from a Medicare-approved provider such as St. Marie's. Under Medicare you pay nothing for the care, up to $5 per prescription for symptom-relief medications, and up to 5% of the Medicare-approved amount for inpatient respite care. Room and board is not covered. Michigan Medicaid and many private plans also cover hospice, with benefits that vary. Hospice is covered when a physician certifies a life expectancy of six months or less if the illness runs its usual course.
How St. Marie's Charges for Hospice Care
St. Marie's bills your insurance, whether that's Medicare, Medicaid or a private plan, a daily rate based on the level of care your loved one needs that day. Families pay only what their coverage leaves, such as the small Medicare copays and room and board described below.
There is no menu of prices, because the daily rate is set by the payer. That's why we can't quote a number before we know your coverage, and why the same care can cost different families different amounts.
| Level of care | When it's used | What families pay under Medicare |
|---|---|---|
| Routine home care | Everyday hospice care wherever your loved one lives | Nothing for the care itself |
| Continuous home care | A short crisis, when mainly nursing care is needed around the clock at home | Nothing for the care itself |
| General inpatient care | Pain or symptoms that can't be managed at home | Nothing when the hospice arranges it |
| Respite care | A short stay in a facility to give caregivers a break; up to 5 days at a time | Up to 5% of the Medicare-approved amount |
What You Pay, in Plain Terms
| Item | Under Original Medicare |
|---|---|
| Nursing, physician, aide, social work, chaplain and bereavement support | No charge when provided by your hospice |
| Medications for pain and symptom relief | Up to $5 per prescription |
| Medical equipment and supplies related to the illness | Covered through the hospice care plan |
| Inpatient respite care | Up to 5% of the Medicare-approved amount |
| Room and board at home, in a nursing home or assisted living | Not covered |
| Treatment meant to cure the terminal illness | Not part of hospice |
| Care for an unrelated problem, such as a broken hip | Original Medicare or your plan applies, with usual deductibles and coinsurance |
These figures come from Medicare.gov and can change, so we confirm them with you at admission. See the Medicare Hospice Benefit for more.
Who Pays for Hospice Care, Payer by Payer
| Coverage | Who pays for hospice | What you may still owe |
|---|---|---|
| Original Medicare (Part A) | Medicare pays the hospice for care related to the terminal illness | Up to $5 per symptom-relief prescription; up to 5% for respite care; room and board |
| Medicare Advantage | Original Medicare pays for hospice, even if your loved one stays in the plan | Plan premiums; usual costs for care unrelated to the terminal illness |
| Medigap (Medicare Supplement) | Works alongside Original Medicare | Policies generally cover the hospice drug and respite copays |
| Michigan Medicaid | Medicaid, including Medicaid health plans, covers hospice | Nursing facility room and board is handled separately |
| Private or employer insurance | The plan pays according to its hospice benefit | Copays, deductibles and limits that vary by plan |
The question we hear most is about Medicare Advantage. If your loved one is in an Advantage plan from UnitedHealthcare, Humana, Aetna, Blue Cross or anyone else, Original Medicare pays for the hospice care and the plan stays in place for other benefits such as dental and vision. Many families assume they must leave their plan. They don't.
For Medicaid, the main question is usually room and board in a nursing home, which isn't part of the hospice benefit. Medicaid may help with it in some situations, so give us the details and we'll check. Private plans differ on copays, on respite limits, and on whether they want to approve the admission first.
St. Marie's works with Medicare, Medicaid and many private plans, including Blue Cross Blue Shield of Michigan, UnitedHealthcare, Cigna, Molina Healthcare and Health Alliance Plan (HAP). If yours isn't named, call and we'll check it with you. Not sure you have coverage at all? Call before assuming hospice is out of reach. Many people qualify for Medicare or Medicaid without realizing it, and our social work team can help you sort out the options.
Checking Your Coverage and Approvals
With Original Medicare, eligibility rests on a physician's certification rather than a plan approval. Medicare Advantage, Medicaid health plans and private insurers sometimes want to be notified or to approve the admission, and that paperwork is where families lose days they don't have. Here's the simple way through it:
Have the insurance cards in front of you, including any Medicare, Medicaid, supplement or private cards.
Call St. Marie's and share the plan names and member numbers. Our team can start the process with your plan.
We'll explain what each plan covers for hospice and what, if anything, you may owe.
A physician certifies eligibility, and your loved one or their representative chooses hospice.
Not sure it's time yet? See signs it's time for hospice.
What It Costs in Common Situations
At home: hospice covers the care, medications and equipment related to the illness. Your normal household costs continue.
In a nursing home: hospice covers the hospice care. The facility's room and board continues to be billed separately, paid privately or, in some cases, through Medicaid.
In assisted living: hospice covers the hospice care. Rent and the facility's own services stay your responsibility.
How to Avoid Surprise Bills
- Call the hospice first, not 911. Emergency room visits, ambulance rides and outside providers the hospice didn't arrange can be billed to the family.
- Ask any hospice what you'd pay for medications, equipment and facility care before you sign.
- Tell us if your coverage changes, such as switching plans or entering a facility.
Our 24/7 on-call nurses are there so a 2 a.m. emergency doesn't turn into an avoidable bill.
Common Questions
Who pays for hospice care?
Medicare pays for most hospice care, including for Medicare Advantage members. Michigan Medicaid and many private insurance plans cover it too. Families generally owe little or nothing for the care itself, though room and board is not covered.
How much does hospice cost?
There is no fixed price list. For most families the care itself costs little or nothing out of pocket. Under Medicare you pay nothing for the care, up to $5 per symptom-relief prescription, and up to 5% for inpatient respite care. Room and board is not covered.
How does St. Marie's charge for hospice care?
St. Marie's bills your insurance a daily rate based on the level of care. Families pay only what their coverage leaves, such as Medicare copays and room and board. Because the rate is set by the payer, there's no fixed price list, and one short call tells you what you'd pay.
Does Medicare cover hospice 100%?
Medicare covers hospice care from a Medicare-approved provider with no charge for the care itself, but not entirely. Prescriptions for symptom relief can carry a copayment of up to $5, inpatient respite care can cost up to 5%, and room and board isn't covered.
Does Medicare Advantage cover hospice?
Original Medicare pays for hospice and related care even if your loved one stays in a Medicare Advantage plan, such as those from UnitedHealthcare, Humana or Aetna. The plan generally continues to cover other benefits, and you still pay its premiums.
Does Medicaid cover hospice in Michigan?
Yes. Michigan Medicaid, including coverage through Medicaid health plans, covers hospice. Room and board in a nursing facility is handled separately, so call us and we'll look at your situation.
Will we get a bill if my loved one goes to the emergency room?
Possibly. Emergency room visits, ambulance rides and outside providers that the hospice didn't arrange can be billed to the family. Call the hospice first, day or night, so the team can arrange what's needed.
Talk With Our Team
If you're weighing hospice and worried about cost, call and ask. We'll look at your coverage with you and tell you plainly what to expect.
St. Marie's Hospice is Medicare-certified and CHAP-accredited, serving Wayne, Oakland, and Macomb counties.