Hospice with a Medicare Advantage plan

What changes when you elect hospice

Medicare Advantage plans, sometimes called Part C, are private plans that take the place of Original Medicare for most of your care. Hospice is the exception. Under federal rule 42 CFR 422.320, once a plan member elects hospice, Medicare pays the hospice directly through Original Medicare (Part A). The plan does not pay for hospice and does not need to approve it.

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.

You do not leave the plan. You stay enrolled, and you keep paying the plan's premium if you want to keep its extra benefits, such as dental, vision, hearing or rides to appointments. If you stop paying the premium, you lose those extras, not your hospice care.

Who pays what once hospice starts

This table is general information, not a benefits determination. We verify your benefits and explain them to you before care starts.

Plans you may see in the Inland Empire

Medicare Advantage plans that are common in San Bernardino and Riverside counties include Kaiser Permanente Senior Advantage, SCAN, UnitedHealthcare, Humana, Alignment Health and IEHP DualChoice, which is for people who have both Medicare and Medi-Cal. They are named here only as examples of Medicare Advantage plans. Listing a plan does not mean Beta Hospice has a contract with it.

For hospice itself, a plan contract is not what decides. Original Medicare pays the hospice, so you may choose any Medicare-certified hospice whatever plan you are in.

The hospice carve-in test has ended

From 2021 through 2024, CMS tested letting some Medicare Advantage plans pay for hospice themselves. The test was part of the Value-Based Insurance Design (VBID) model, and people called it the hospice carve-in. Members of the plans in the test could be steered toward hospices in the plan's network.

The hospice part of the test ended on December 31, 2024. The whole VBID model ended on December 31, 2025. In 2026, every Medicare Advantage member's hospice is paid by Original Medicare. If an older article or a plan handbook says your plan pays for hospice or limits you to its hospices, it describes that test, which is over.

If you have Medicare Advantage and are thinking about hospice

1. Step 1

   Call a hospice or ask the person's doctor

   Anyone can call. A hospice nurse can explain what the next step would be. Only a doctor can certify that someone is eligible.

2. Step 2

   Have both cards ready

   The hospice bills Original Medicare, so it needs the Medicare number from the red, white and blue card. The plan card tells us about your drug coverage and extra benefits.

3. Step 3

   Tell your plan's care manager

   You do not need the plan's permission to start hospice. Telling the plan keeps your other care coordinated and lets the plan know who is managing the terminal illness.

4. Step 4

   Decide about the premium

   Keep paying it if you want the plan's extra benefits. Hospice care continues either way.

Your choice is protected

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. That includes a hospice your plan did not suggest. If you leave hospice, the plan takes over all of your coverage again, usually from the start of the next month.

Common questions

Read more

The fuller pages: paying for care, who pays for the nursing home on hospice and Medi-Cal and hospice.