Coverage
Does Medicare Cover Palliative Care?
- January 12, 2024
- Reviewed by John Krahnert
Does Medicare Cover Palliative Care?
Yes, Original Medicare (Medicare Part A and Part B) does cover palliative care for beneficiaries who have a terminal illness. Medicare Advantage plans may cover Part A and Part B coverage as well as additional coverage for Palliative care.
In order for Medicare to cover your palliative care, you must qualify for hospice coverage under Medicare Part A by meeting the following conditions:
- Your hospice doctor and regular doctor each certify that you are terminally ill with a life expectancy of six months or less.
- You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your illness and related conditions.
You then must accept palliative care for comfort instead of care designed to cure your illness.
Once under Medicare palliative care coverage, Medicare Part B may cover some treatments and medications that provide palliative care such as visits from doctors, nurses and social workers.
Does Medicare Cover At Home Palliative Care?
Yes, Medicare should cover at home palliative care. Medicare benefits generally cover at home care under Plan A and Plan B, and you should be covered for home care services.
How long does Medicare pay for palliative care?
Palliative care coverage can extend for as long as you need hospice care.
Qualification requires having a life expectancy of six months or less. If the beneficiary is still alive after six months, hospice and palliative care coverage may continue if the patient is re-certified as terminally ill.
What is included in palliative care?
During hospice care, the following services and items may be rendered as a form of palliative care.
- Doctor and nursing care services
- Walkers, wheelchairs, catheters and other equipment designed for comfort or convenience
- Prescription drugs used for symptom or pain relief
- Grief counseling
- Nutritional counseling
- Social work services
- Physical or occupational therapy
- Respite care
Does Medicare cover palliative care for dementia?
Yes, Medicare can cover palliative care for dementia. If a person with dementia meets the above guidelines for hospice care coverage under Medicare, then their palliative care may be covered as well.
Their hospice doctor and their physician must certify that their dementia is terminal with a life expectancy of six months or less if the disease were to run its normal course.
Do Medicare Advantage plans cover palliative care?
Medicare Advantage (Medicare Part C) plans are required by law to provide all of the same benefits as Original Medicare with one exception: hospice care (and the palliative care that comes along with it).
However, if you have a Medicare Advantage plan, your hospice and palliative care will still be covered under Original Medicare. Remember, when you sign up for a Medicare Advantage plan, you are still technically enrolled in Original Medicare as well.
Some Medicare Advantage plans may also cover other benefits not covered by Medicare Part A and Part B.
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What is the difference between hospice care and palliative care?
Hospice care and palliative care are often confused and used interchangeably. However, they are different:
- Hospice care provides end-of-life support for terminally ill patients who have decided to stop curative treatment for their disease or condition.
Medicare beneficiaries are usually eligible for hospice services if a doctor certifies they have six months or less to live.
Palliative care — which is designed to alleviate pain and make patients more comfortable — is just one component of hospice care. It can also include a wide variety of other end-of-life services delivered by a hospice care team, including medical equipment and supplies, social work services, grief and loss counseling for families, spiritual support and other services. - Palliative care isn’t exclusively a hospice care service. Palliative care may be used in conjunction with curative treatment for a number of chronic conditions.
A cancer patient undergoing chemotherapy may need palliative care to help him or her deal with the side effects of the chemotherapy treatment. However, they are still actively pursuing curative treatment, unlike a hospice patient.
Original Medicare (Medicare Part A and Part B) and Medicare Advantage plans (Medicare Part C) may cover palliative care if a doctor says it is medically necessary, even if it is not part of hospice care.
Patients suffering from chronic diseases may be candidates for palliative care. These chronic diseases can include (but aren't limited to):
- Cancer
- Amyotrophic lateral sclerosis (ALS)
- Kidney failure
- Heart disease
- Lung disease
- Alzheimer’s disease
- HIV/AIDS
Always check with your doctor and Medicare provider to see if the palliative care you are considering is covered.
Find a Medicare Advantage plan today
Medicare Advantage plans are privately sold alternatives to Original Medicare. By law, they must cover the same benefits as Original Medicare.
If you receive hospice care, you will still receive it from Medicare Part A.
Some Medicare Advantage plans offer benefits that Original Medicare doesn't offer.
Learn more about the other additional benefits that may be covered by Medicare Advantage plans where you live.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
