If you’re considering palliative care services in your home, you may have many questions about Medicare coverage for these services. What exactly is palliative care, how does it work, and does Medicare cover it? We’ll take a closer look at the details and help you make sense of it all.
The basics: What is palliative care?
Palliative care supports people who are living with a serious illness, condition, or health situation. A specialized medical team works together with the patient's current care team, including primary care and specialists to provide an additional layer of support, including symptom management, emotional, physical and spiritual support.
Palliative care can be provided to people of any age, in any setting. It is provided for as long as needed— with the goal to support the patient and their families or other caregivers in prevention and treatment of the symptoms and side effects of the condition.
Is palliative care the same as hospice care?
Palliative care is often confused with hospice care. A helpful way to distinguish between the two is that hospice care is always palliative, but not all palliative care is hospice care. Hospice focuses on managing symptoms and providing comfort measures during the end-of-life phase of a terminal illness, defined as a life expectancy of six months or fewer. With hospice, curative measures are not taken, and the sole focus is on the quality of the patient’s final stage of life.
Palliative care also focuses on symptom management, comfort, and quality of life. However, it may be provided alongside curative treatment to the patient. It can begin at any stage of a serious illness, and its function is to help patients and their caregivers manage their condition, ideally beginning at the time of diagnosis.
What does Medicare cover during palliative care?
Medicare covers many elements of palliative care as part of a treatment plan for people living with many serious disease types and chronic illnesses.
How palliative care is covered depends on whether the person is enrolled in hospice care for end-of-life support, or if they are using palliative care as a stand-alone service.
Palliative care as part of hospice care
For Medicare to cover palliative care as part of hospice, an individual must meet the following conditions:
- The patient's physician and hospice doctor both must determine that they have a life-limiting illness that results in a life expectancy of 6 months or less.
- The patient must choose to receive palliative care for comfort measures only, rather than treatment to cure their condition or prolong their life.
- The patient must sign a form stating that they choose hospice care rather than treatment-related care.
Medicare generally pays for all services related to hospice care, but it does not cover living expenses if a person is in their own home or in another living facility.
Palliative care as a stand-alone service
If you’re enrolling in palliative care outside of hospice treatment, it's important to check and see if your insurance coverage has certain limits on palliative care, such as a list of what types of serious illnesses are covered, or other situations that may or may not be eligible for palliative care services.
Even if palliative care services aren’t a part of hospice care, Medicare may cover palliative care if your doctor determines it is medically necessary. Let’s break down the different parts of Medicare coverage as they relate to palliative care services:
Medicare Part A is hospital insurance. It covers many of the inpatient and skilled care needed with palliative care. Under Part A, you are covered for:
- Inpatient hospital stays, including the treatment and medication the patient needs while they are in the hospital.
- Short-term stays at a skilled nursing facility, which includes rehabilitation services, medication administration, and daily care.
- Limited home health care. This includes part-time skilled nursing or home health care, and rehabilitation services.
- Hospice care, and any palliative care necessary for comfort at the end of life.
Medicare Part B is medical insurance. If a patient receives palliative care and they are not receiving hospice care, Medicare Part B helps to cover most of the outpatient services that are needed during palliative care. With Part B, you’re covered for:
- Doctor’s appointments needed for the diagnosis, treatment, and prevention of your illness or other related conditions.
- Durable medical equipment, such as walkers and wheelchairs. This includes any equipment that may be needed for treatment or to make you more comfortable.
- Mental health counseling for the patient, family and caregivers during care.
- Outpatient rehabilitation therapy, which includes speech therapy, physical therapy, or occupational therapy as needed.
Medicare Part C is also known as Medicare Advantage. This is a Medicare option sold by private insurance companies. With Medicare Advantage, you’re automatically covered for the same services as Medicare Part A and Part B, including those for palliative care. Part C plans may also cover:
- Prescription drugs for treatment or to help ease any symptoms.
- Long-term care, which may include skilled healthcare services or help with activities of daily living, such as bathing, dressing, or eating.
Companies that sell Medicare Advantage plans may also offer different plan options to fit individual needs. For people with serious illnesses, Special Needs Plans (SNPs) offer additional medical services and have greater flexibility that may provide superior options for long-term or life-limiting conditions, including the services provided as part of palliative care.
Medicare Part D is prescription drug coverage. Part D may cover medications required during palliative care such as antidepressants, anti-anxiety medications,, antipsychotics, stool softeners, antidiarrheals, and analgesics (pain relief).
What portions of palliative care are NOT covered under Medicare?
- Although Medicare covers most of the costs of palliative care, there may be additional expenses, such as copayments on pain management prescription drugs, and for hospital and medical care.
- Medicaid, specific charities, and other state-run programs may provide additional support options, ranging from emotional to financial aid.
These decisions can feel overwhelming and tricky to navigate. Our dedicated specialists can help you determine if it is time to consider palliative treatment and provide guidance and support to you or your loved one. Find Amedisys services near you.
- Does Medicare Cover Palliative Care? Medicare Coverage and Benefits - https://www.medicareadvantage.com/coverage/does-medicare-cover-palliative-care
- Healthline: Medicare and Palliative Care - https://www.healthline.com/health/medicare/does-medicare-cover-palliative-care#:~:text=Medicare%20covers%20palliative%20care%20as,care%20services%20that%20Medicare%20covers
- Medicare Advantage Plans Cover All Medicare Services - https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services
- Medicare: Does Medicare Cover Palliative Care - https://www.medicare.org/articles/does-medicare-cover-palliative-care/
- Medicare Part A: Medicare and & Medicare Advantage Info, Help and Enrollment - https://www.medicare.org/medicare-part-a/