Medicare Advantage and Hospice: How It Works

Here's the rule that surprises almost everyone: when a Medicare Advantage enrollee elects hospice, the hospice care is paid by Original Medicare, not the Advantage plan. The patient keeps their Advantage plan for care unrelated to the terminal illness. Hospice is still fully covered; the payment just flows through a different door.

If your loved one has a Medicare Advantage plan and hospice is on the table, here's what changes, what doesn't, and what you don't need to worry about.

Quick Refresher: Advantage vs. Original Medicare

Original Medicare is the traditional federal program. Medicare Advantage plans (sometimes called Part C) are offered by private insurers as an alternative way to receive Medicare benefits, often with networks and extra perks.

Plenty of Eastern Oregon seniors have Advantage plans. And many of their families assume that means the plan controls everything, including hospice. For hospice specifically, it doesn't.

Who Pays for Hospice on a Medicare Advantage Plan?

When an Advantage enrollee elects hospice:

• Original Medicare pays for the hospice care. The Medicare Hospice Benefit applies in full: visits from nurses, aides, social workers, and chaplains; medications related to the hospice diagnosis; medical equipment; and supplies, covered at 100%.
• The patient stays enrolled in their Advantage plan. The plan continues to cover care unrelated to the terminal illness under its normal rules.

Nothing is canceled, and the family doesn't file anything. The hospice and Medicare handle billing directly. Our overview of what the Medicare Hospice Benefit covers applies fully here.

Does the Advantage Plan's Network Limit My Hospice Choice?

Generally, no, and this matters in rural Oregon. Because hospice is paid by Original Medicare rather than the Advantage plan, the plan's network doesn't dictate which hospice you use. You can choose any Medicare-certified hospice serving your area.

That means the right questions when choosing a hospice aren't about networks. They're about responsiveness, local presence, and whether a team member answers the phone at 2 a.m.

What Stays With the Advantage Plan?

Care unrelated to the hospice diagnosis. A few examples of how the split works:

Situation	Who pays
Hospice nurse and aide visits	Original Medicare (hospice benefit)
Pain and symptom medications for the terminal illness	Original Medicare (hospice benefit)
Hospital bed, oxygen, supplies	Original Medicare (hospice benefit)
Care for an unrelated condition	The Medicare Advantage plan, per its usual rules

When it's unclear whether something is related to the hospice diagnosis, the hospice team makes that determination and explains it. You shouldn't have to argue with anyone.

One practical note: keep using the Advantage plan's normal process (its network, its referrals, its copays) for the unrelated care it still covers. The hospice election changes who pays for hospice; it doesn't rewrite the rules for everything else.

Do Benefit Periods and Eligibility Work the Same Way?

Yes. Eligibility still requires a physician to certify a life expectancy of six months or less if the illness runs its normal course. Coverage still runs in two 90-day benefit periods followed by unlimited 60-day periods with recertification, explained in Medicare hospice benefit periods.

And the patient can still leave hospice at any time and return to treatment. If that happens, the Advantage plan resumes its role for that care. See how revoking the hospice benefit works.

What Should Families Actually Do?

Very little, honestly. When you call a hospice:

1. Have the Medicare card and the Advantage plan card available.
2. Let the hospice verify coverage; that's their job, not yours.
3. Ask them to explain, in plain words, what's covered and who pays for what.

There's no special enrollment step, no plan change to make, and no penalty for electing hospice.

How Engrace Hospice Can Help

Engrace Hospice is locally owned and based in Pendleton, serving Umatilla County, Morrow County, and Eastern Oregon within about 50 miles. We work with patients on Original Medicare and every Medicare Advantage plan, handle the billing details with Medicare directly, and keep a team member on call 24/7. More background lives on our Medicare Hospice Benefits page, and our hospice costs page answers the money questions families ask most.

If your loved one has an Advantage plan and you're unsure how hospice would work, call us at (541) 263-7494. We'll sort out the coverage details so you can focus on each other.

Frequently Asked Questions

Does Medicare Advantage cover hospice?

When a Medicare Advantage enrollee elects hospice, the hospice care itself is paid by Original Medicare, not the Advantage plan. The patient keeps their Advantage plan for care unrelated to the terminal illness. Either way, hospice is fully covered.

Do I have to leave my Medicare Advantage plan to start hospice?

No. You stay enrolled in your Advantage plan. Original Medicare pays for the hospice care, and your Advantage plan continues to cover unrelated care according to its usual rules.

Can I use any hospice if I have a Medicare Advantage plan?

Because hospice is paid by Original Medicare, the Advantage plan's network generally doesn't restrict your hospice choice. You can choose any Medicare-certified hospice that serves your area.

Will hospice cost more with Medicare Advantage than with Original Medicare?

No. In both cases, the Medicare Hospice Benefit covers hospice care at 100%: care team visits, medications related to the diagnosis, equipment, and supplies. The payment simply comes through Original Medicare.