Hospice and Medicare Advantage Plans

Hospice care is covered for all Medicare beneficiaries through Medicare Part A, including beneficiaries enrolled in a Medicare Advantage plan.

 

If you have a Medicare Advantage plan, sometimes called Medicare Part C, and choose hospice care for a terminal condition, you are eligible to receive hospice care coverage through Medicare Part A. This does not mean you are required to drop your Medicare Advantage plan.

 

Your Medicare Advantage plan continues to provide supplemental health services, such as vision or dental and Medicare Part D (the prescription drug benefit), that are not related to your terminal illness. Original Medicare (Parts A and B) is also available to cover any other services not related to the terminal illness care provided by the hospice. Part A covers mostly inpatient care and Part B covers mostly outpatient care.

A real-world example

A patient who has a Medicare Advantage plan is receiving chemotherapy for end-stage cancer. At a certain point, with a prognosis of six months or less to live, she chooses to stop receiving curative treatment and transitions to hospice care.

 

Medicare Part A covers her hospice services including nursing care, medical equipment, spiritual care and family support, expert pain management and advance care planning.

 

Her health care for a preexisting diagnosis unrelated to her terminal illness, such as diabetes, may be covered by original Medicare while her vision, dental and other supplemental services continue to be provided by her Medicare Advantage plan.

 

The patient may choose to disenroll from her Medicare Advantage plan when she transitions to hospice; however, she would lose the supplemental coverage offered by her Medicare Advantage plan, which may include options for drug coverage, dental, vision and reduced co-pays.

Medicare Advantage hospice coverage is changing

In 2021, Medicare may offer the option to receive hospice benefits directly through a Medicare Advantage plan in a few counties. More information on this limited pilot project, sometimes called the Medicare Advantage carve-in, will be available in 2020.

Medicare Advantage plans, often referred to as Medicare Part C, are Medicare coverage options offered by private insurance companies that are approved by the U.S. Centers for Medicare & Medicaid Services (CMS). Medicare Advantage includes HMO, PPO, and fee-for-service plans that cover the services of Original Medicare, other than hospice, and often add additional coverage for vision, drug and dental care.