MA Beneficiaries More Likely than Fee-for-Service Patients to Enter Hospice from Community Setting

Medicare Advantage (MA) beneficiaries are more likely to enroll in hospice from a community setting than patients in traditional fee-for-service programs.

More than 46% of MA beneficiaries who enrolled in hospice in 2018 did so while in their homes (rather than a hospital or nursing facility), compared to 38% who were covered by traditional Medicare, a study published in JAMA Health Forum found. 

“We found that hospice enrollees in MA had substantially different hospice use patterns, with greater enrollment from community settings, compared with their counterparts in [traditional Medicare],” the authors wrote. “While we found that hospice length of stay was longer for those enrolling from the community vs hospital or nursing home settings, we overall found that hospice length of stay among MA enrollees was only slightly longer than for those in [traditional Medicare].”


For this study, researchers examined medical records for a cohort of nearly 3.2 million patients who elected hospice in the last 90 days of life during the years 2011, 2013, 2016 and 2018.

Years prior to 2018 showed similar patterns. In 2011, for example, 50% of MA patients came to hospice from the community, compared to 39% of those in traditional Medicare.

However, researchers said more investigation is necessary to identify the reasons behind this trend.


“It is unclear why MA beneficiaries were more likely to enroll in hospice from the community,” the study indicated.

As of 2023, nearly 31.5 million beneficiaries receive coverage from Medicare Advantage plans, according to the U.S. Centers for Medicare & Medicaid Services (CMS) data released this week. This is close to half of all Medicare beneficiaries. Since 2007, MA enrollment has risen 337%, a recent study in Health Affairs found.

Medicare Advantage currently does not cover hospice care. CMS is testing potential future reimbursement through MA via the hospice component of the value-based insurance design (VBID) model demonstration, which is now in its third year.

The JAMA study identified trends in length of stay as an area for future research.

“Given the substantial increase in the number of MA beneficiaries, including those at the end of life, this finding fills a gap in our understanding of how MA is associated with care and yet leaves many unanswered questions, particularly as to why there was little change in hospice length of stay by insurance type despite the increase in persons enrolling from the community,” the authors wrote.

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