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Medicare Advantage And End Of Life Care: What You Should Know

By Adrienne Keller
If you’re enrolled in Medicare Advantage and begin to need hospice care, you will be covered.

With Medicare Advantage plans, you will be covered for hospice-related expenses provided by Medicare-approved providers. Once certified as terminally ill by your hospice doctor, you qualify for hospice services for at least six months. Here, we bring you more details about accessing hospice care while enrolled in Medicare Advantage, using the official U.S. government website for Medicare as a guide. 

Medicare Advantage and Hospice

If you are enrolled in a Medicare Advantage plan, such as an HMO or PPO, and you need to access hospice care services, begin by consulting your specific plan in order to find an approved provider near you. Your plan must help you find Medicare-approved hospice care providers in your area.

In order to qualify for end-of-life care, also known as hospice care, on Medicare Advantage, your primary care doctor (if you have one) and your hospice doctor must certify that you are terminally ill and only have six months or less to live. Patients that live longer than six months may qualify forspice care. 

This is how it works. You will initially receive hospice care in two 90-day benefit periods. These periods can be followed by an unlimited number of 60-day periods, as long as the hospice medical director or other hospice doctor certifies that you are still terminally ill at the beginning of each period. Additionally, you’ll have the option to switch hospice providers once during each benefit period. 

Once you begin receiving hospice care, the services are provided through Original Medicare (Part A), though you can still maintain your Medicare Advantage plan to cover conditions unrelated to your terminal illness. The hospice benefit is designed to cover all needs related to your terminal illness and associated conditions.

In addition to you and your family, members of your hospice care team may include:

  • Hospice doctors
  • Your primary care doctor
  • Nurses
  • Mental health counselors
  • Social workers
  • Physical and occupational therapists
  • Speech-language pathologists
  • Hospice aides
  • Homemakers
  • Volunteers

The goal of hospice care provided by Medicare is to keep you and your family together and comfortable. Hospice care is provided in your own home unless inpatient care is needed. Your hospice team will help determine if inpatient care at a hospital is necessary. It is important to let your hospice provider arrange any inpatient care needed, to ensure coverage through your hospice benefit.

If your illness goes into remission and you no longer need hospice care, you can stop hospice care at any time. If you were in a Medicare Advantage Plan prior to starting hospice, you can return to the plan, so long as you continue to pay the plan’s premiums. You can also go back into hospice care at any time, when eligible.

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.