Updated September 2026. Written and reviewed by the Lily Hospice clinical team.
If your loved one has a Medicare Advantage plan, hospice is still covered, paid by Original Medicare Part A rather than the plan. Nobody has to drop the plan, it keeps covering unrelated care, and any Medicare-certified hospice in Michigan can be chosen, not only in-network ones.
Many of the families who call us have a parent on a Medicare Advantage plan, and most of them ask the same worried question in the first minute: “Is hospice even covered under her plan?” The answer is yes, and the way it works surprises people. This article explains what changes when a Medicare Advantage member elects hospice, what does not change, and the small piece of recent history that still causes confusion. It is written for families in Oakland, Macomb and Wayne counties, but the rules are federal and apply everywhere.
First, the one thing to know
Medicare Advantage plans (sometimes called Part C, or by the insurer’s brand name) are private plans that take the place of Original Medicare for most care. Hospice is the exception. When a Medicare Advantage member elects hospice, the hospice benefit comes from Original Medicare Part A, exactly as it would for someone who never joined an Advantage plan. Original Medicare pays the hospice directly. The Advantage plan does not pay for hospice and does not decide which hospice you use.
That is why the plan’s network does not limit your choice. Any Medicare-certified hospice in Michigan can care for a Medicare Advantage member. Our provider-neutral metro Detroit hospice directory lists every certified hospice in the three counties so families can compare.
What changes when hospice begins
Who pays for hospice. Original Medicare Part A pays the hospice a daily rate, and the hospice arranges and pays for everything related to the terminal illness: nursing visits, the aide, the social worker and chaplain, medications for comfort, the hospital bed and other equipment, supplies, short inpatient stays when symptoms need them, respite for the caregiver, and bereavement support for the family afterward. For most families the out-of-pocket cost is close to zero. The only possible charges are up to $5 per prescription for symptom-control drugs and 5% of the Medicare-approved amount for an inpatient respite stay. Our page Does Medicare cover hospice in Michigan? lists the whole benefit line by line.
Who coordinates care for the terminal illness. Once hospice is elected, care related to the terminal illness comes from the hospice or is arranged by it. If your father goes to an emergency room for a problem related to his illness without the hospice involved, that visit may not be covered. So the first call, day or night, is to the hospice, not to the plan and not to 911 unless the nurse has said otherwise. A real person answers our line at any hour, and a nurse comes when needed.
The plan is told. The hospice files the Medicare hospice election, and the Advantage plan is notified through Medicare’s systems that its member is on hospice. Families do not have to call the plan to “switch on” hospice, and there is no plan pre-approval for hospice itself.
Treatment meant to cure the terminal illness stops being covered. This is true for every hospice patient, not only Advantage members. Some treatments that exist for comfort, such as radiation to shrink a painful tumor, can be part of the hospice plan of care. The hospice physician explains what is and is not included before care begins.
What does not change
The plan stays in force. Nobody has to leave a Medicare Advantage plan to use hospice. Your mother keeps her card, her plan and her premium arrangement exactly as they were.
Unrelated care is still the plan’s job. If she is on hospice for heart failure and needs her eye drops refilled, her dentist seen or a broken wrist set, the Advantage plan keeps covering that care under its usual rules, networks and copays. The hospice social worker and nurse help families sort out what is related to the terminal illness and what is not, and the hospice takes on the related part.
Plan drug coverage and extras continue. The plan’s Part D drug coverage keeps paying for medications unrelated to the terminal illness. Medications for comfort and for the terminal illness move to the hospice. Extras the plan offers, such as dental, vision or a fitness benefit, are unaffected by hospice.
Her own doctor can stay. The plan’s primary care physician, or any physician she chooses, can remain her attending physician on hospice, working with the hospice team. Many doctors appreciate having a hospice nurse in the home between appointments. Can I keep my own doctor on hospice?
She can change her mind. A hospice patient can revoke hospice at any time and return to full plan coverage, including treatment meant to cure, and can elect hospice again later. Nothing about hospice is a one-way door. Families can also switch from one hospice to another if the fit is wrong.
The recent history that still confuses people
For a few years, a small Medicare test let some Advantage plans pay for hospice directly for their members, inside the plan. That test ended on December 31, 2024. Since then, for every Medicare Advantage member, hospice is billed to Original Medicare Part A, exactly as it was before the test. If a friend or a plan brochure from that period told you that “the plan handles hospice,” that is no longer how it works, and it never changed the underlying rule that a member may choose any Medicare-certified hospice. The rule itself is described on Medicare.gov’s hospice care page, and the end of the test is documented on the Centers for Medicare & Medicaid Services’ announcement page for the hospice component of its Value-Based Insurance Design model.
What this looks like in practice
Picture a daughter in Livonia who calls on a Sunday about her father, who has advanced COPD and a Medicare Advantage plan through his former employer. A neighbor has told her hospice “isn’t in the plan.” On the call we take the plan name and his Medicare number and verify coverage before the visit: hospice is covered through Original Medicare Part A, and his Advantage plan stays as it is for everything else. The nurse visits that afternoon; within two days the hospital bed, oxygen and comfort medications are in the house, and his plan’s primary care doctor stays on as attending physician. Nothing about his plan changed, and nothing about hospice was blocked by it.
The same holds for a mother in a Warren assisted living apartment or a husband in a Wayne County nursing home. Where the person lives and which plan they carry changes our paperwork, not whether hospice is covered. What happens on the first hospice visit.
Medicaid, VA and private plans, briefly
Families sometimes have more than one kind of coverage. Michigan Medicaid includes a hospice benefit that mirrors Medicare’s, and for someone with both, Medicare pays the hospice while Medicaid may cover nursing-facility room and board. Veterans enrolled in VA health care may receive hospice through the VA or through community hospices the VA authorizes; most veterans also have Medicare, which can pay for hospice directly. Most private and employer plans have a hospice benefit modeled on Medicare’s, with details that vary. We verify whatever coverage exists on the first call and explain it in plain words before anything begins, including for families with Medicaid only or no insurance.
Open enrollment, in one sentence
Because hospice is paid by Original Medicare regardless of the Advantage plan, changing or keeping a plan during Medicare’s fall open enrollment does not change hospice coverage; it only affects the unrelated care the plan pays for. We will publish a fuller guide to open enrollment and hospice later this season.
How long it lasts
The Medicare hospice benefit is not limited to six months and does not run out. Medicare covers two 90-day benefit periods followed by unlimited 60-day periods, with the hospice physician recertifying at the start of each that the person still qualifies. That is the same for Advantage members as for everyone else. How long does hospice last? If you are still deciding whether it is time to ask, start with Is It Time? A family’s gentle guide.
Lily serves families at home, in assisted living, memory care and nursing facilities throughout Oakland, Macomb and Wayne counties, from our office in Troy.
Common questions
Does Medicare Advantage cover hospice?
Yes. Hospice for a Medicare Advantage member is paid through Original Medicare Part A, and the plan continues to cover unrelated conditions. The member keeps the plan.
Do we have to use a hospice in the plan’s network?
No. Because hospice is paid by Original Medicare, the plan’s network does not apply. Any Medicare-certified hospice in Michigan can be chosen.
Does the plan need to approve hospice first?
No. There is no plan pre-authorization for the Medicare hospice benefit. A physician certifies eligibility, the patient elects hospice with a Medicare-certified hospice, and the hospice files the election.
Will my mother lose her plan’s dental, vision or drug coverage?
No. The plan and its extras stay in force. Its drug coverage keeps paying for medications unrelated to the terminal illness; the hospice provides medications for comfort and for the terminal illness.
Can she keep her plan’s primary care doctor?
Yes. Her own physician can remain the attending physician and work with the hospice team.
What happens if she goes to the ER?
Call the hospice first, at any hour. Emergency care related to the terminal illness that the hospice did not arrange may not be covered; care for an unrelated problem is still handled by the plan.
What did the 2024 change actually do?
A small Medicare test that let some Advantage plans pay for hospice directly ended on December 31, 2024. Since then every Advantage member’s hospice is billed to Original Medicare Part A, as it was before the test.
Is there anything we will pay?
Possibly up to $5 per prescription for symptom-control drugs and 5% of the Medicare-approved amount for an inpatient respite stay. Everything else related to the terminal illness is paid by Medicare, and any exception is explained before care starts.
Hospice isn’t giving up. It’s showing up. Call (248) 955-5100. A real person answers, 24 hours a day, and will check your loved one’s coverage before you decide anything.
General education, not legal, financial or medical advice. Coverage details are set by Medicare and by each plan; the hospice verifies them for every family before care begins. Sources: Medicare.gov, “Hospice care” (medicare.gov/coverage/hospice-care); Centers for Medicare & Medicaid Services, VBID Model Hospice Benefit Component announcement (cms.gov/priorities/innovation/innovation-models/vbid/vbid-hospice-announcement).
