Medicare Advantage and Hospice: Who Pays and What the Plan Must Disclose

Medicare Advantage hospice ownership disclosure requires a plan to present all available hospice providers objectively and state any hospice ownership interest held by the plan or an entity related to it. Original Medicare pays for hospice even when the patient remains enrolled in Medicare Advantage. The insurer can therefore have a financial interest in the hospice receiving the patient while another part of Medicare pays the bill. We compare the provider list with the ownership statement to see what the plan told the member about its stake.

Who Pays Hospice If the Patient Has Medicare Advantage?

Original Medicare pays the hospice when a Medicare Advantage member elects the hospice benefit. The member can remain enrolled in the plan, and the plan’s ownership of a hospice leaves that payment arrangement in place.

The Medicare Advantage hospice rule describes the payment change precisely. Medicare stops its regular monthly payment to the plan for medical care, leaving any beneficiary rebate and prescription drug payment. Original Medicare pays the hospice for hospice care. It also pays the plan, provider or supplier for other Medicare-covered services furnished to the member, under the usual payment rules.

The timing matters to anyone who reconciles enrollment and payments. That reduction takes effect on the first day of the month after the hospice election. It runs until the first day of the month after the election ends.

The Medicare Payment Advisory Commission has recommended bringing hospice into Medicare Advantage since March 2014 because the carve-out splits financial responsibility and accountability for care. That recommendation was never enacted. The plan’s continuing relationship with its member and the hospice’s responsibility for terminal care still have to meet across that payment boundary.

Does a Medicare Advantage Member Stay in the Plan?

Yes. Unless the member disenrolls, the hospice election leaves Medicare Advantage enrollment in place. The member remains entitled through the plan to benefits outside the hospice’s responsibility.

That continuing relationship matters. The plan still has a member to inform, even though the hospice receives payment from Original Medicare. Treating the election as the end of the plan’s involvement misses the disclosure obligation at the moment the member is choosing a provider.

Hospice takes responsibility for care related to the terminal illness and related conditions. Coverage for unrelated health care continues. The distinction between those services is also where separate billing for care already included in the hospice payment becomes consequential. We connect the election and the care records to the claims when an insider sees costs moving between payers.

What Happened to the Medicare Advantage Hospice Carve-In?

The Medicare Advantage hospice carve-in ended when the Hospice Benefit Component of the Value-Based Insurance Design model closed on December 31, 2024. The broader VBID model ended separately on December 31, 2025. The hospice component’s earlier end is the date that matters for hospice payment.

As of September 2026, hospice remains outside the ordinary Medicare Advantage benefit package. The demonstration’s end returned the payment question to the ordinary carve-out described above.

From 2021 through 2024, the voluntary component let participating insurers include the Medicare hospice benefit in their plans. Its purpose was to bring responsibility for cost, quality and outcomes together, improving coordination while maintaining budget neutrality or reducing costs. CMS’s evaluation shows what that meant in practice.

Participating insurers had to offer palliative care and transitional concurrent care. The latter allowed members choosing an in-network hospice to continue some curative care after electing hospice. Insurers could also offer hospice supplemental benefits, such as reduced cost sharing for hospice drugs or inpatient respite care.

What the Demonstration Delivered

CMS found low use of the added services. In its findings for 2023, fewer than 1% of beneficiaries starting hospice received transitional concurrent care. About 7% received at least one hospice supplemental benefit. Palliative care use was lower than insurers expected.

The provider network changed the business relationship too. In 2023, 55% of beneficiaries starting hospice chose an in-network provider, up from 37% in 2021. Members could still choose an out-of-network hospice without additional cost sharing. In-network hospices were larger and more likely to belong to chains, while scoring similarly on the quality measures CMS examined.

Hospices reported low reimbursement, delayed payments and different data-reporting and communication requirements across insurers. Hospices joined networks primarily to protect the future of their businesses. For a hospice administrator, the experiment involved contracts, payment delays and access to patients as well as the promise of better coordination.

CMS cited increasing operational challenges and limited, declining insurer participation in ending the hospice component.

Who Owns Hospice?

Insurers can own a hospice outright or retain a minority interest. UnitedHealth Group’s purchase of Amedisys and Humana’s interest in Gentiva show why the ownership disclosure clause matters beyond the name on a hospice’s sign. A plan that hides its stake deprives families of information Medicare requires it to give them.

UnitedHealth Group and Amedisys

UnitedHealth Group completed its purchase of Amedisys on August 14, 2025. The transaction followed a Justice Department challenge and divestitures involving BrightSpring Health Services and The Pennant Group.

Amedisys had built a substantial hospice business through acquisitions. Its annual filing for 2020 described 180 hospice care centers in 35 states and called the company the country’s third-largest hospice provider.

The divestitures make the local provider’s identity important. Home health and hospice centers were included in the BrightSpring transaction, while the Pennant transaction covered home health centers.

Humana and Gentiva

Humana sold a majority interest in its hospice and personal-care business to Clayton, Dubilier & Rice in 2022 and retained a 40% minority interest in Gentiva. Its sale announcement described the disposal of a majority stake, rather than a complete exit.

The disclosure rule reaches any ownership interest held by the plan or an entity related to it. Its wording therefore reaches beyond wholly owned hospices. An insider examining the member’s provider options needs the ownership relationship that existed when the plan presented them.

Common Ownership and Referral Disclosure

When a Medicare Advantage plan refers a member to a hospice under common ownership, referral disclosure must tell the member about the plan’s financial interest. The plan must both present all available hospice providers objectively and state its hospice ownership interests, including those held through an entity related to it.

The duty applies when a Medicare hospice program is in the plan’s service area or when referring patients to hospice programs outside that area is common practice.

A provider directory supplies names. An ownership statement supplies information about the plan’s own stake in a choice. To examine the presentation, we look at the alternatives the member received, how the plan described them and what it said about ownership. A dated letter, referral script or provider list can make that comparison concrete.

Why the Choice Has Economic Weight

Hospice’s daily payment makes attracting patients consequential. A 2026 working paper from Kansas State University, Quality, Reputation, and Reimbursement Design in the Hospice Industry, models California hospices competing for patients through reputation. It uses annual hospice data from 39 California counties for 2002 through 2018, measures quality through visits per patient per day and finds that reputation plays a significant role in consumer choice.

In the paper’s model, stronger reputation effects improve quality, while lower Medicare reimbursement worsens it. A hospice spends money on care partly to earn the reputation that brings future patients. How a plan presents the choices matters to the businesses competing for those patients and to the families choosing among them.

The Documents Behind the Provider List

A dated plan communication and a dated ownership record let us compare what the member heard with who held the financial interest. Public ownership information gives that inquiry a starting point beyond the brand name.

The Department of Health and Human Services’ January 2025 ownership analysis describes CMS’s Hospice All Owners and Hospice Change of Ownership datasets. The transaction file includes effective dates and information about buyers and sellers, including their National Provider Identifier, CMS Certification Number, organization name and business name.

Hospices self-report ownership information through Medicare’s Provider Enrollment, Chain, and Ownership System, known as PECOS, electronically or by mail using Form CMS-855A. The form also asks whether an organization with an ownership stake is itself owned by another organization or individual. HHS describes CMS’s definitions of private equity companies and real estate investment trusts for this reporting. Those disclosures can help trace ownership beyond the immediate owner named on a provider list.

Those identifiers help connect the company in a filing to the hospice in a provider list. The transaction date helps connect ownership to the time the member received the recommendation. We examine the plan’s account and the ownership history together.

An insider who knows how the list was prepared can explain the decisions behind the document the member saw.

From the Referral to the Medicare Claim

A hospice fraud inquiry follows the instructions, financial arrangements and claims behind the patient’s care. Plan staff may know how a hospice was selected for a referral. Hospice intake staff may know what the plan said. Billing and compliance staff may know which services Medicare paid for and which concerns reached management.

Allegations of hospice referral kickbacks led to a $1.4 million settlement with Tapestry Hospice in 2024. The Justice Department alleged that medical directors’ compensation rose and fell with referrals. The alleged arrangement put the patient count inside the pay calculation. Knowingly paying to buy referrals can make the resulting Medicare claims false even when the patients qualify for hospice. Where an insider’s concern involves paid referrals, we connect the compensation terms and payments to the referral records and claims.

For insiders considering a hospice whistleblower case, we connect the conduct to the government’s payments and build the case around what the insider knows. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know How the Hospice Was Chosen

If you work inside a plan or hospice and know how ownership interests affected the options members received, speak with our whistleblower experts about those referrals. We connect your knowledge of the patient handoff, the ownership and the payments to build your strongest case. We bring in healthcare fraud whistleblower lawyers who understand Medicare Advantage and hospice payment, and remain your partners through the case.