Does Medicare Cover Palliative Care

Key Takeaways

Palliative care can provide relief from pain and other symptoms of a serious or chronic illness.
Medicare will cover palliative care, both in and out of hospice care, if it is deemed medically necessary.

Palliative care plays a crucial role in the process of managing a serious or chronic condition, providing comfort and support to patients and their families. In this article, we'll explore the details of Medicare coverage for palliative care, including what it covers and how to access it.

What Is Palliative Care?

Palliative care is a specialized form of healthcare that focuses on providing relief from the symptoms and stress of a serious illness. It is an interdisciplinary type of care that involves multiple types of providers. While it's common for people with terminal illness to receive palliative care, people with complex chronic conditions may also benefit from it. It is designed to improve the quality of life for both the patient and their family.

Palliative care can be provided at any age and any stage of a serious illness, alongside curative treatments, and is not limited to end-of-life care or hospice. Palliative care can be delivered in various settings, including hospitals, clinics, and at home.

Key aspects of palliative care include:

Symptom Management: Addressing pain, shortness of breath, nausea, and other symptoms.
Emotional and Psychological Support: Providing counseling and resources for patients and their families.
Care Coordination: Ensuring that all aspects of the patient's care are well-coordinated and aligned with their goals and values.

Medicare Coverage Basics

Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as some younger people with disabilities. It is divided into several parts, each covering different aspects of healthcare:

Medicare Part A: Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Medicare Part B: Covers outpatient care, doctor visits, medical supplies, and some preventive services.
Medicare Part C (Medicare Advantage): Offers an alternative way to receive Medicare benefits through private insurance plans.
Medicare Part D: Covers prescription drugs.

Medicare Coverage of Palliative Care

Medicare does cover palliative care, but the specifics depend on the type of care and the Medicare Part involved.

Medicare Part A and Palliative Care

Inpatient Hospital Stays: If you are admitted to the hospital for a serious illness, Medicare Part A will cover the palliative care services provided during your stay.
Skilled Nursing Facility Care: If you need skilled nursing care, Medicare Part A will cover palliative care services in a skilled nursing facility.
Hospice Care: While hospice care is a form of palliative care, it is specifically for patients with a life expectancy of six months or less. Medicare Part A covers hospice care, including palliative services, if you choose to enroll in a hospice program.

Medicare Part B and Palliative Care

Outpatient Services: Medicare Part B covers outpatient palliative care services, such as doctor visits, consultations, and therapy sessions.
Medical Supplies and Equipment: Part B also covers certain medical supplies and equipment needed for palliative care, such as oxygen and wheelchairs.
Home Health Services: If you need palliative care at home, Medicare Part B covers home health services [link to new article], including nursing care and physical therapy.

Medicare Part C (Medicare Advantage) and Palliative Care

Comprehensive Coverage: Medicare Advantage plans are required to cover all services that Original Medicare (Parts A and B) covers, including palliative care.
Additional Benefits: Many Medicare Advantage plans offer additional benefits, such as transportation to medical appointments and coverage for over-the-counter medications, which can be particularly helpful for palliative care.

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How long will Medicare cover palliative care?

Outside of hospice care, Original Medicare will cover palliative care as long as it’s deemed medically necessary and care is received from Medicare-approved providers. Hospice care has its own distinct cost structure. Once a person enters hospice care, which includes palliative care, they typically receive two 90-day benefit periods followed by unlimited 60-day periods as long as recommended by their provider.

How does palliative care differ from hospice?

Palliative care and hospice care both aim to provide comfort and support, but they differ in scope and timing. Palliative care is a broader approach that can be provided at any stage of a serious illness, alongside curative treatments, focusing on symptom management and emotional support. Hospice care, a specific type of palliative care, is designed for patients with a life expectancy of six months or less, focusing on end-of-life support, pain management, and assistance with daily activities, typically in the patient's home or a hospice facility. In hospice, attempts to cure the illness are generally stopped.