Original Medicare (Medicare Part A and Part B) does cover palliative care for beneficiaries who have a terminal illness.
In order for Medicare to cover your palliative care, you must qualify for hospice coverage under Medicare Part A by meeting the following conditions:
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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.
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.
During hospice care, the following services and items may be rendered as a form of palliative care.
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.
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 home health care items and services, such as bathroom grab bars and home meal delivery, both of which are not covered by Medicare Part A and Part B.
Hospice care and palliative care are often confused and used interchangeably. However, they are different:
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):
Always check with your doctor and Medicare provider to see if the palliative care you are considering is covered.
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, such as prescription drug coverage and caregiver support services.
Learn more about the other additional benefits that may be covered by Medicare Advantage plans where you live.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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