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Monotropa hypopitys is the most widespread member of its subfamily (Monotropoideae). Outside of North America, its wide distribution includes India, China, Pakistan, Russia, and much of Europe. In the United States, the heath family (Ericaceae) mycotrophic species are most common in the western mixed coniferous forests. M. hypopitys distribution is influenced by the host distribution, specifically that of Tricholoma fungi.

M. hypopitys flowering phenology typically ranges from April to December but is dependent on the geographic region and flower morph. Its two dominant color forms, red and yellow, have non-overlapping reproductive phenologies. The yellow form blooms in mid-summer while the red morph is known to flower in the fall. While both forms are self-compatible, the yellow form has higher rates of autogamous reproduction. Pollinator diversity within the Monotropa genus is low with bumblebees being the predominant pollen dispersal agent. The red and yellow morphs also have distinct floral systems with the red form displaying approach herkogamy. The yellow form is devoid of the spatial separation of reproductive structures associated with herkogamy.

M. hypopitys non-photosynthetic nature is attributed to its significantly reduced chloroplast genome. When it was originally classified, only two species, M. hypopitys and M. uniflora, made up the Monotropa genus. Recent analysis of morphological characteristics and genetic information suggests that M. hypopitys is more closely related to the other members of the Monotropoideae subfamily than it is to M. uniflora.