Does Medicare Cover Palliative Care?

Does Medicare Cover Palliative Care?

• Working with a palliative care specialist allows people with serious illnesses to maintain their physical, emotional, and spiritual quality of life.
• Medicare covers palliative care as part of treatment for long-term illnesses and hospice care for terminal illnesses.
• Inpatient care, outpatient care, and mental health counseling are just a few of the palliative care services that Medicare covers.

​Hospice care and palliative care are two types of services that many Medicare beneficiaries may need in their lifetime. When you have a serious illness, palliative care plays an important role in maintaining your quality of life.

Medicare beneficiaries who choose palliative care are covered under original Medicare or Medicare Advantage. In this article, we’ll explore what palliative care is, the benefits it can offer, and the specific services Medicare covers.

What is palliative care?

Palliative care helps improve the physical, mental, social, and spiritual quality of life for those with serious or life-threatening illnesses.
When diagnosed with a serious illness, you may choose to receive palliative care in addition to any other ongoing treatments. In this case, palliative care aims to maintain your quality of life throughout your illness.
If you’ve been diagnosed with a terminal illness with less than 6 months to live, you may seek hospice care. In this situation, care centers around providing a good quality of life until the end of life.

If you opt to receive palliative care for your illness, the services you receive are based your specific needs. Palliative care services may include:

• pain relief for physical symptoms
• emotional support for mental and spiritual needs
• understanding the treatment options for the illness
• help in making decisions for your treatment and care
• overall support for the illness whether treatment is being sought or not

Palliative care vs hospice care

While both of these types of care are somewhat similar, there is a difference between palliative and hospice care:

• Hospice care is a type of end-of-life medical care that provides emotional and physical support for patients with terminal illnesses. It is reserved for those with a life expectancy of 6 months or less. Hospice care focuses on relieving the symptoms of the illness, supporting the emotional and spiritual health, and helping with any important decisions regarding the end of life. When you receive hospice care, this care takes the place of any curative or life-prolonging treatments you would otherwise receive.
• Palliative care focuses mainly on improving your well-being if you a serious illness. Palliative care offers a support system to your and your family so you can continue to have a good quality of life. Unlike hospice care, those receiving palliative care can continue to undergo curative or life-prolonging treatments.

Palliative care and hospice care both focus on supporting your overall well being when you have a serious illness. However, hospice care is reserved for the end of life, when you’ve chosen not to have any further treatments to cure your illness.

What does Medicare cover for palliative care?

Original Medicare and Medicare Advantage both cover palliative care, both with and without hospice care, when it is deemed medically necessary. Here’s what is covered by each part of Medicare.

Part A

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. This includes any treatments or services you may need during your stay.
• Short-term stays at a skilled nursing facility. Services include rehabilitation services, medication administration, and other day-to-day care.
• Limited home health care. This includes part-time skilled nursing or home health aide care and rehabilitation services.
• Hospice care. You are covered for any palliative care necessary for comfort at the end of life.

Part B

Medicare Part B is medical insurance. It covers most of the outpatient services that are needed during palliative care. With Part B, you are covered for:
​

• Doctor’s appointments. These may be needed for the diagnosis, treatment, and prevention of your illness or other related conditions.
• Durable medical equipment. This includes any equipment that may be needed for treatment or to make you more comfortable.
• Mental health counseling. Emotional support and counseling may be needed for yourself or your loved ones during your care.
• Rehabilitation therapy (as an outpatient). This includes speech therapy, physical therapy, or occupational therapy as needed.

Part C

Medicare Part C is also known as Medicare Advantage. This is a Medicare option sold by private insurance companies. With Medicare Advantage, you are automatically covered for the same services as Medicare Part A and Part B, including those for palliative care. Under Medicare Advantage, you might also be covered for some additional services, such as:

• Prescription drugs. These may be for treatment or to help ease any symptoms.
• Long-term care. This may include skilled healthcare services or help with everyday personal needs such as help with 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 flexibility that may better for long-term or serious conditions.

Part D

Medicare Part D is prescription drug coverage. Part D may cover medications needed during palliative care. According to the World Health Organization Trusted Source, medications are commonly prescribed for the following conditions during palliative care:

• anorexia
• anxiety
• constipation
• delirium
• depression
• diarrhea
• dyspnea
• fatigue
• mucus buildup
• nausea
• vomiting
• pain