Kaiser Senior Advantage and hospice: you can choose your hospice

Can a Kaiser Senior Advantage member choose a hospice outside Kaiser?

Yes. Kaiser's own Southern California home health and hospice FAQ says Medicare and Senior Advantage members may choose any Medicare-certified hospice that is not part of Kaiser Permanente.

The reason is a federal rule. Kaiser Permanente Senior Advantage is a Medicare Advantage plan. Under 42 CFR 422.320, once a Medicare Advantage member elects hospice, Original Medicare pays the hospice directly. The plan does not pay for hospice and does not approve or deny it. CMS repeats this in its Medicare Managed Care Manual, chapter 4, section 10.2.2.

Kaiser runs its own hospice program, and many members choose it. Choosing hospice is your decision. You can stop hospice at any time and return to regular Medicare coverage. You have the right to choose your hospice.

Does Kaiser pay for hospice?

Not for Senior Advantage members. Original Medicare (Part A) pays the hospice, whichever Medicare-certified hospice you choose.

Medicare covers hospice care related to the terminal illness. Under Medicare, most people pay nothing for hospice care itself. There can be a copay of up to $5 per prescription for symptom medicines and 5% of the Medicare amount for inpatient respite care. Medicare does not pay room and board where you live.

From 2021 through 2024, a Medicare test let some plans pay for hospice themselves. The hospice part of that test ended on December 31, 2024. In 2026 no Medicare Advantage plan, Kaiser included, pays for its members' hospice care.

What stays with Kaiser once hospice starts?

Once a Senior Advantage member elects hospice, the hospice manages care for the terminal illness. Kaiser keeps the rest: care unrelated to the terminal illness, drug coverage for other conditions and the plan's extra benefits.

This table is general information, not a benefits determination. Your plan's Evidence of Coverage is the final word on Kaiser's own benefits. We verify your benefits and explain them to you before care starts.

How do you ask your Kaiser doctor or case manager for hospice?

Tell your Kaiser doctor, or the Kaiser case manager or social worker, that you want to talk about hospice. If you already know which hospice you want, say so by name. Kaiser's FAQ notes that, inside Kaiser, the first step is a doctor's referral to Kaiser's hospice department.

If you want a hospice outside Kaiser, you can also call that hospice directly. You do not need Kaiser's permission to choose a Medicare-certified hospice. Have your red, white and blue Medicare card and your Kaiser card ready. Telling Kaiser keeps your other care coordinated.

Leaving a Kaiser hospital with hospice

In the Inland Empire, Kaiser's hospitals include Fontana Medical Center, Ontario Medical Center, Riverside Medical Center and Moreno Valley Medical Center. Before discharge, the steps are the same at each.

1. Step 1

   Ask for the case manager or social worker on the unit

   They plan the discharge. Tell them the person wants hospice at home, and which hospice, if you have chosen one.

2. Step 2

   Give the hospice's name and phone number

   The case manager sends the records and orders. The hospice then speaks with the family, and with the doctor if needed, about the next step.

3. Step 3

   Plan the first night at home

   Ask the hospice what equipment and medicines will be ready, and who to call that night. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed.

What if the Kaiser doctor does not sign for an outside hospice?

Hospice still can start. Under 42 CFR 418.22, the hospice's medical director, or a hospice physician, certifies that the person is terminally ill, together with the attending physician if the person has one. Eligibility is decided by doctors: Hospice is for people with a serious illness when a doctor certifies that life expectancy is six months or less if the illness runs its usual course. Our medical director and your doctor make that determination. A website cannot.

When you elect hospice, you name an attending physician if you want one (42 CFR 418.24). That can be your Kaiser doctor, if they agree to serve, or the hospice physician. Some Kaiser doctors work with outside hospices and some prefer not to. Either way, you can choose.

Kaiser members who also have Medi-Cal

If you have Medicare and Medi-Cal and your Medicare plan is with Kaiser, Original Medicare still pays the hospice first, and you may choose any Medicare-certified hospice. Medi-Cal helps with what is left, such as nursing facility room and board for residents who qualify.

If you have Medi-Cal only through Kaiser, with no Medicare, the rules are different. Kaiser is then your Medi-Cal managed care plan, and a Medi-Cal plan may ask members to use a hospice in its network (DHCS All Plan Letter 25-008). Kaiser members with an employer or individual plan also follow their plan's rules. In both cases, ask Kaiser member services, or call us and we check for you. See Medi-Cal and hospice.

Can you leave hospice, or switch back to Kaiser's hospice?

Yes. You can stop hospice at any time. If you leave hospice, Kaiser takes over all of your coverage again, usually from the start of the next month. You can elect hospice again later if you are still eligible.

You can also change hospices, for example from an outside hospice to Kaiser's hospice or the other way around. Medicare allows one change of hospice in each benefit period. See switching hospice providers and can you leave hospice?

Common questions

Read more

The fuller pages: hospice with a Medicare Advantage plan, paying for care, is it time for hospice?, how to start hospice and going home from the hospital on hospice.

Beta Hospice serves San Bernardino County, Riverside County, Los Angeles, Orange and Ventura counties from one office in San Bernardino. Kaiser Permanente is named on this page only to describe its members' rights. Beta Hospice is not part of Kaiser Permanente.