For hospital case managers and plan care managers
Medicare Advantage members and hospice: a note for case managers
A Medicare Advantage member who elects hospice can choose any Medicare-certified hospice. Original Medicare pays the hospice from the date of election, the plan does not authorize it, and the member stays enrolled in the plan. This applies to every plan in 2026: the hospice part of the CMS VBID test ended on December 31, 2024. The rules and their sources are below.
Reviewed by Jack Demirchyan, Chief Operating Officer, October 22, 2026
On this page (6 sections)
The rules in one table
| Question | Answer | Rule |
|---|---|---|
| Who pays the hospice? | Original Medicare, from the date of election. The hospice bills Medicare as it would for any fee-for-service patient. | 42 CFR 422.320(c)(3); Claims Processing Manual ch. 11, sec. 30.4 |
| Does the plan authorize hospice? | No. The plan is not billed for hospice and does not approve or deny it. | 42 CFR 422.320(c) |
| Can the plan limit the member to its own hospices? | No. The member chooses the hospice on the election statement. When a plan tells members about hospice, it must present all available hospices objectively and state any ownership interest it has in a hospice. | 42 CFR 418.24(a); 42 CFR 422.320(a) |
| Does the member leave the plan? | No. The member stays enrolled and keeps the plan's supplemental benefits and its Part D drug coverage for drugs unrelated to the terminal illness. | 42 CFR 422.320(b) |
| Who pays for care unrelated to the terminal illness? | Original Medicare, from the date of election, under the usual Medicare rules. | Claims Processing Manual ch. 11, sec. 30.4 |
| What if the member revokes hospice? | Original Medicare keeps paying until the first day of the following month. Then the plan resumes all of the member's coverage. | Claims Processing Manual ch. 11, sec. 30.4 |
General information about Medicare rules, not a benefits determination for any member. We verify each patient's coverage before care starts.
What happened to the VBID hospice carve-in?
From 2021 through 2024, the CMS Value-Based Insurance Design (VBID) model let some Medicare Advantage plans cover hospice themselves, and members of those plans could be steered to the plan's hospices. CMS ended the hospice part of the model at 11:59 pm on December 31, 2024, and the whole model ended on December 31, 2025.
A plan handbook, an intake script or an EHR workflow written during the test may still say the plan covers hospice or must approve it. For 2026, that is out of date: the federal rule in force says Original Medicare pays the hospice for every Medicare Advantage member.
Members who also have Medi-Cal
For a member with both Medicare and Medi-Cal, including members of dual-eligible special needs plans, Medicare pays the hospice in the same way. Medi-Cal benefits, such as room and board for a member who lives in a nursing facility, follow the Medi-Cal plan's own rules, which can include its hospice network. Call us before the referral and we check the member's Medi-Cal plan.
Referring a Medicare Advantage member to Beta
- Step 1
Send the referral as for any patient
Call (877) 258-7129 at any hour, fax (855) 563-3575, or use the referral page. Include the Medicare number from the red, white and blue card as well as the plan card. No plan authorization number is needed for hospice.
- Step 2
We check coverage and contact the family
Referrals get a response within two hours, 24 hours a day. A hospice nurse or other licensed hospice staff member explains the benefit, and only the patient or legal representative elects hospice.
- Step 3
Let the plan's care manager know
The plan does not approve hospice, but telling its care manager keeps the member's other benefits and unrelated care coordinated. We can make that call with you.
- Step 4
We report back
We tell you the outcome: admitted, declined, not eligible or still deciding.
Patients have the right to choose their hospice provider. Beta Hospice does not offer anything of value in exchange for referrals.
Common questions from case managers
Do Kaiser Permanente Senior Advantage members count?
Yes. They may choose any Medicare-certified hospice, and Original Medicare pays for it. Kaiser also runs its own hospice program, and some members prefer it. The choice is the member's.
The plan's hospice list does not include the hospice the family wants. Can they still choose it?
Yes, if it is Medicare-certified. A plan's list can help a family find options, but for Medicare hospice the plan's network does not limit the choice.
Does the plan's case management stop when hospice starts?
No. The member stays in the plan. The hospice manages the terminal illness and related conditions; the plan keeps its supplemental benefits and its role in coordinating unrelated care.
Could the rules change?
Proposals to move hospice into Medicare Advantage come up in Congress from time to time. None was in effect when we checked the rules on October 22, 2026. We review this page every six months.
Related pages
For the family: hospice with a Medicare Advantage plan. For you: discharge planners and case managers, health plans and IPAs and how to verify a hospice.
About this page
- Written by
- Beta Hospice care team
- Reviewed by
- Jack Demirchyan, Chief Operating Officer
- Last reviewed
- October 22, 2026
- Next review
- April 22, 2027
How we write and review this site
Sources
- 42 CFR 422.320: Special rules for hospice care (Medicare Advantage) (opens in a new tab)
- 42 CFR 418.24: Election of hospice care (opens in a new tab)
- CMS Medicare Claims Processing Manual, chapter 11, section 30.4: Claims from Medicare Advantage organizations (opens in a new tab)
- CMS: Hospice benefit component of the VBID model ends December 31, 2024 (opens in a new tab)
- CMS Innovation Center: Value-Based Insurance Design (VBID) model (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
Refer a patient or ask a clinical question
Call any time. A nurse can talk through eligibility, timing and logistics for your patient.
Patients have the right to choose their hospice provider.