Yes, Medicare Advantage plans must cover hospice, but you switch to Original Medicare to use it
If you are enrolled in a Medicare Advantage plan and choose hospice care, your plan must cover the hospice benefit. However, the way this works is different from how Advantage plans cover other services. When you elect hospice, you automatically move to Original Medicare (Medicare Part A and Part B) for your hospice care and related services. Your Medicare Advantage plan ends, and Original Medicare pays for hospice instead.
This is a federal requirement — every Medicare Advantage plan must allow you to access hospice without losing your coverage. But because hospice is a specialized service with its own payment rules, Medicare handles it separately from the rest of your medical care.
Key Takeaways
- Electing hospice through a Medicare Advantage plan automatically switches you to Original Medicare for hospice services and related care.
- Original Medicare covers the full cost of hospice care — there are no copays, coinsurance, or deductibles for hospice services themselves.
- Your Medicare Advantage plan ends when you elect hospice, but you can return to an Advantage plan later if you leave hospice.
- Hospice covers medical care, medications, equipment, and support services related to your terminal condition, not treatment aimed at cure.
- You must have a doctor's statement that you have six months or less to live, though you can continue hospice beyond that if your condition warrants it.
What Original Medicare covers when you choose hospice
Once you elect hospice and move to Original Medicare, Medicare Part A covers the full cost of hospice services. This includes nursing care, doctor visits, medications related to your terminal condition, medical equipment like oxygen or a hospital bed, home health aide services, counseling, and spiritual care. There are no copays or coinsurance charges for any of these services.
Original Medicare also covers short-term inpatient care if you need it — for example, if your pain becomes difficult to manage at home or you need a brief hospital stay for symptom control. Respite care, which allows your family caregiver a break, is also covered for up to five days at a time.
The hospice provider bills Medicare directly. You do not handle the billing or pay out of pocket for hospice-related services. If a service is not related to your terminal condition, it may not be covered, and your hospice team can explain what falls outside the benefit.
How the switch from Advantage to Original Medicare works
When you tell your doctor you want hospice care, your doctor will refer you to a hospice agency. The hospice agency handles the paperwork to enroll you in the hospice benefit. As part of that process, your Medicare Advantage plan is terminated, and you are moved to Original Medicare automatically.
You do not have to call your Advantage plan or Medicare to make this happen — the hospice agency coordinates it. However, you should notify your Advantage plan that you are electing hospice so there is no confusion about which plan is active. After your Advantage plan ends, you will no longer pay the monthly premium for that plan.
If you have prescription drug coverage through your Advantage plan (Part D), that coverage ends when you switch to Original Medicare. Hospice covers medications related to your terminal condition, so this is usually not a problem. If you need a medication not related to your hospice diagnosis, you can get a separate Part D plan, though this is uncommon during hospice.
What happens to your Advantage plan benefits when you elect hospice
Your Medicare Advantage plan ends completely when you elect hospice. Any remaining benefits — such as dental, vision, or hearing coverage — are no longer available. Copays and deductibles from your Advantage plan no longer explore because you are now on Original Medicare.
If you had a supplemental insurance plan (Medigap) before your Advantage plan, you may not be able to re-enroll in the same Medigap plan after hospice ends, depending on your state's rules. It is worth asking your insurance broker about this before you elect hospice, so you understand what your options are if you survive longer than expected or decide to leave hospice.
Can you return to a Medicare Advantage plan after hospice
Yes, you can return to a Medicare Advantage plan if you leave hospice or if hospice ends. When you are no longer receiving hospice care, you move back to Original Medicare. During the next Annual Enrollment Period (October 15 to December 7 each year), you can enroll in a Medicare Advantage plan again.
If you leave hospice during the year and want to switch plans before the next enrollment period, you may be able to make changes during a Special Enrollment Period. Contact Medicare at 1-800-MEDICARE to ask whether you may have access to for an earlier switch.
Be aware that if you had a Medigap plan before your Advantage plan, re-enrolling in Medigap after hospice may be more difficult or more expensive, depending on your state and how long you were away from it. This is another reason to discuss your options with a broker or your State Health Insurance information Program (SHIP) before you elect hospice.
What you need to know about the six-month prognosis requirement
To be admitted to hospice, a doctor must certify that you have a terminal condition and are expected to live six months or less if the disease runs its normal course. This does not mean hospice will end after six months. If you are still alive and still need hospice care after six months, your doctor can recertify you, and you can continue receiving services.
Many people receive hospice for longer than six months. The six-month rule is a threshold for entry, not a time limit on the benefit. If your condition improves and you no longer need hospice, you can leave the program and return to regular medical care at any time.
How to prepare before you elect hospice
Before you choose hospice, talk to your doctor about what to expect and what services the hospice agency will provide. Ask whether your current medications will be covered and whether the hospice agency works with specialists you may want to see.
If you have a Medigap plan or other supplemental coverage, contact your insurance broker or your State Health Insurance information Program to understand how electing hospice will affect your coverage after hospice ends. This conversation takes 15 minutes and can save you money and confusion later.
You can also ask your hospice agency which Original Medicare services are covered and which are not. Hospice agencies are required to explain the benefit clearly before you enroll.
Frequently Asked Questions
Do I have to give up my Medicare Advantage plan to use hospice?
Yes. When you elect hospice, your Advantage plan ends and you move to Original Medicare. This is automatic and required by law. However, you can return to an Advantage plan later if you leave hospice or if hospice ends.
Will I have to pay copays for hospice services?
No. Original Medicare covers hospice services with no copays, coinsurance, or deductibles. You may have a small copay (up to $5) for medications, but hospice-related medications are usually covered in full.
What if I want to stop hospice and go back to treatment?
You can leave hospice at any time. When you do, you return to Original Medicare. During the next Annual Enrollment Period, you can enroll in a Medicare Advantage plan again if you wish. Talk to your doctor about your options before you make this decision.
Does hospice cover pain medication and other drugs?
Yes. Hospice covers all medications related to your terminal condition and symptom management, including pain medication. Medications not related to your hospice diagnosis may not be covered, but this is rare during hospice care.
Can my family get paid to be my hospice caregiver?
Hospice does not pay family members to provide care. However, hospice does cover respite care — temporary inpatient care that gives your family a break. Respite care is covered for up to five days at a time and is available multiple times during your hospice stay.