End-of-Life Care: The Effects of Medicare Advantage versus Original Medicare

Timely hospice enrollment is associated with improved quality of life,¹ reductions in unnecessary and burdensome care,² and a greater likelihood of a patient dying in their preferred setting.³ Nevertheless, nearly a third of patients with advanced cancer do not enroll.⁴ As such, greater rates of timely enrollment are broadly considered to be a quality indicator.

Because Medicare ranks as the largest payor for both cancer treatment and hospice in the U.S., Medicare plans and policies significantly affect the delivery of care.^5,6 This is further influenced by the prevalence of Medicare Advantage plans. Those are privately managed alternatives to Original Medicare. Slightly more than half of people in Texas have Medicare Advantage plans.⁷ With 69 plans available, the Houston area is especially competitive for Medicare Advantage plans with more than a quarter of a million of seniors in our region enrolled.⁸ An unusual feature of Medicare Advantage plans has been shown to significantly affect end-of-life care, and in a way many doctors might not expect. Most doctors who treat terminal illness are aware that Medicare Advantage plans do not cover hospice. When these patients want to enroll in hospice, they are automatically transferred into Original Medicare coverage. Multiple studies now support the conclusion that this relationship improves timely enrollment in hospice.⁹

Patients who have Medicare Advantage plans prove more likely to use hospice, to begin hospice from community care (as opposed to inpatient settings), to have longer hospice stays, and to die at home. For example, compared to patients with Original Medicare, patients with Medicare Advantage plans prove nearly 7% more likely to use hospice, and their hospice care lasts more than five days longer, on average.⁹

The prevailing theory is that the hospice carve-out from Medicare Advantage plans creates a financial incentive for insurance companies to transfer patients to Original Medicare at the end of life. In cases of terminal disease, absent hospice, the last months of life tend to see the highest medical costs in a patient’s life. Timely initiation of hospice reduces expenses. Medicare Advantage plans use predictive analytics to identify patients in need of end-of-life planning and deploy care-management practices designed to facilitate palliative care. This trend suggests that hospice utilization patterns are affected by healthcare management practices. The better aspects of these practices can be adopted at the individual practice level. Timely end-of-life care planning leads to timely hospice enrollment, which in turn leads to higher quality of life and greater family satisfaction.¹⁰

For referring physicians, the practical lesson is clear: earlier conversations can help patients and families make more informed decisions before a crisis forces the issue. Avatar Home Health & Hospice supports that process with responsive, Medicare-certified hospice and palliative care throughout Greater Houston, The Woodlands, Harris County, and Montgomery County. When a patient’s goals of care begin shifting from disease-directed treatment to comfort, dignity, and support at home, Avatar can help physicians, patients, and families coordinate a timely transition that honors both clinical realities and personal wishes. We are available to your patients for a no-obligation conversation about hospice at the place of your patient’s choosing: the hospital, their home, your office, our office, etc.

References

1. Mulville AK, Widick NN, Makani NS. Timely referral to hospice care for oncology patients: a retrospective review. Am J Hosp Palliat Care. 2019;36(6):466-471.
2. Kelley AS, Deb P, Du Q, Aldridge Carlson MD, Morrison RS. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Aff (Millwood). 2013;32(3):552-561.
3. Lysaght S, Ersek M. Settings of care within hospice: new options and questions about dying “at home”. J Hosp Palliat Nurs. 2013;15(3):171-176.
4. Cagle JG, Lee J, Ornstein KA, Guralnik JM. Hospice utilization in the United States: a prospective cohort study comparing cancer and noncancer deaths. J Am Geriatr Soc. 2020;68(4):783-793.
5. Park J, Look KA. Health care expenditure burden of cancer care in the United States. Inquiry. 2019;56: 46958019880696.
6. Fine PG. Hospice underutilization in the U.S.: the misalignment of regulatory policy and clinical reality. J Pain Symptom Manage. 2018;56(5):808-815.
7. Mark Farrah Associates. Record growth rates for Medicare Advantage plans, lowest for PDPs [Internet]. McMurray (PA): Mark Farrah Associates; [date unknown; cited 2026 Jun 10]. Available from: https://www.markfarrah.com/mfa-briefs/record-growth-rates-for-medicare-advantage-plans-lowest–pdps/
8. Emerson J. Medicare Advantage penetration by state | 2024 [Internet]. Chicago (IL): Becker’s Healthcare; 2024 Aug 9 [cited 2026 Jun 10]. Available from: https://www.beckerspayer.com/payer/medicare-advantage-penetration-by-state-2024/
9. Hu X, Jiang C, Kwon Y, Geng F, Fan Q, Shi KS, Zheng Z, Zhao J, Warren JL, Yabroff KR, Han X. Medicare plan switching and hospice care among decedents with advanced cancer. JAMA Network Open. 2026 Mar 24;9(3):e260755.
10. Yamaguchi T, Maeda I, Hatano Y, Mori M, Shima Y, Tsuneto S, Kizawa Y, Morita T, Yamaguchi T, Aoyama M, Miyashita M. Effects of end-of-life discussions on the mental health of bereaved family members and quality of patient death and care. Journal of Pain and Symptom Management. 2017 Jul 1;54(1):17-26.