What Happens to Your Medicare Advantage Plan If You Enter Hospice

Hospice is one of the more misunderstood transitions in Medicare, particularly for people enrolled in a Medicare Advantage plan rather than Original Medicare. The rules are specific, and knowing them ahead of time can prevent confusion during an already difficult period.

Hospice Is Always Covered Through Original Medicare

Regardless of whether you are enrolled in a Medicare Advantage plan, hospice care itself is covered under Original Medicare Part A once you elect it. This is sometimes called a hospice "carve-out." Your Medicare Advantage plan does not pay for your hospice benefit — Original Medicare does, directly.

What Stays With Your Medicare Advantage Plan

Care unrelated to your terminal condition — for example, a broken bone from a fall, or your regular Part D drug coverage if your plan includes it — generally still runs through your Medicare Advantage plan as before. You typically remain enrolled in your plan the entire time; hospice does not require you to disenroll.

Why This Distinction Matters

Because Original Medicare pays for the hospice benefit itself, your Medicare Advantage plan's usual rules around networks and prior authorization do not apply to hospice services. Any Medicare-certified hospice provider can generally provide your hospice care, not just ones in your plan's network.

Questions Worth Asking When Hospice Comes Up

• Will I need to disenroll from my Medicare Advantage plan? (Usually no.)
• Which of my current medications and services are hospice-related versus unrelated?
• Who do I contact for non-hospice-related care while I am receiving hospice services?

This is exactly the kind of situation where a quick conversation with your plan or a licensed agent can clarify what stays the same and what changes, so the coverage question is one less thing to manage during a difficult time.