Does Medicare Cover Palliative Care?

If you are undergoing treatment for a severe health condition and struggling with side effects, you may benefit from palliative care. A team of health care professionals in different specialties manages your care. Together, they work to help alleviate your pain and provide emotional, social and practical support. Some people refer to palliative care as supportive care. The focus of palliative care is on enhancing the quality of life for you and your family.

Members of your palliative care team may include a :

• Palliative care specialist
• Social worker
• Nutritionist
• Chaplain

Settings where you may receive palliative care:

• Hospital
• Nursing home
• Outpatient palliative care facility
• Patient’s home

Palliative care might transition to hospice services. Hospice is a type of palliative care. In both scenarios, the goal is to make you more comfortable, not to cure your illness. The primary distinction is that palliative care can happen at any stage of your illness, whereas hospice care begins when recovery is not expected.

Medicare Part A is the hospital insurance segment of Original Medicare. In addition to inpatient benefits, Medicare Part A covers hospice care. 

Medicare Part A for hospice services

Typically, Medicare-certified hospice care is delivered where you live, such as your own private home or a nursing home. But first, you need to meet the qualifications:  

• Your physician or a hospice physician must certify that you are terminally ill (life expectancy of six months or less).
• You agree to receive care to make you as comfortable as possible with no expectation of a cure.
• You will have to sign a document that confirms you have elected to receive hospice care rather than Medicare-covered treatments.

If you qualify for hospice services, Medicare Part A covers:

• Pain relief and symptom management supplies and services
• Medical, nursing and social services
• Medication for pain management
• Durable medical equipment as needed to relieve pain and manage symptoms
• Services provided by an aide or homemaker
• Other services, which may include spiritual and grief counseling

Your cost for hospice services

If you satisfy the Medicare Part A requirements, hospice services will not cost you anything. As for your medication to manage pain and symptoms, you are responsible for a copayment of up to $5 for each prescription. 

Respite care is when you are cared for in a Medicare-approved facility during your caregiver’s time off for rest. For each period of respite care, the maximum time allowed is five days. Your payment to the facility will be 5% of the Medicare-approved amount.

Even if you are a Medicare Advantage plan member, hospice care is billed to Original Medicare. 

Home health services

Medicare Part A and/or Part B covers home health services, but this benefit is not the same as palliative care. The goal of home health care is to treat your condition. If your health care provider certifies that you are homebound and need to be treated at home, you may qualify for:

• Medical social services
• Physical or occupational therapy
• Services for speech-language pathology
• Skilled nursing care (part-time or intermittent)
• Home health aide services for personal hands-on care (part-time or intermittent)
• Durable medical equipment
• Medical supplies for home use
• Injectable osteoporosis drugs

Resources

Here are a few resources to expand your research for information on palliative care and hospice services:

• National Institute of Aging
• American Society of Clinical Oncology (ASCO)

MULTIPLAN_HCIMB28PAL_2022