Does Medicare Cover Palliative Care?
Key Takeaways
- Palliative care helps people with chronic conditions live more comfortably. If you are diagnosed and living with a terminal illness while on Medicare, your palliative care is covered.
- If a doctor recommends palliative care, Medicare typically pays for 80% of the cost for each service.
- If you’re receiving hospice care while receiving treatment for an illness, you typically receive two 90-day benefit periods followed by unlimited 60-day periods as long as recommended by your doctor.
- Palliative care and hospice are not the same things. Palliative care acts like an umbrella, while hospice is care you can elect when you receive an end-of-life diagnosis and stop treatment.
- Medicare covers palliative care before and during hospice care.
Does Medicare cover palliative care? Yes, Medicare covers aspects of palliative care, like specialists, physical therapy, and home health services, but each service has its own eligibility requirements. Medicare also offers hospice care, which includes palliative care, as a distinct benefit. For any services, you may have to pay a portion of the cost. This article explores how palliative care and Medicare work, and how much these services cost.
What Is Palliative Care?
Palliative care is a special form of care for people with serious illnesses, such as kidney disease, cancer, or Alzheimer’s. It takes a collaborative, holistic approach to health, considering the person’s physical comfort and emotional well-being. A team of doctors, nurses, and other healthcare professionals work alongside the individual and their family members to provide an extra layer of support.
Individuals may get help performing their daily tasks, managing their finances, or formulating a treatment plan. Palliative care is available at any stage in the person’s illness, unlike hospice care, which is designed for end-of-life support.
About 13 million Americans live with a serious illness that could be eased with palliative care. And since older adults have a higher risk of developing multiple chronic conditions, it’s important to understand how Medicare covers these life-improving services. Most insurance plans, including Medicare, cover palliative care in some way.
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How Medicare Covers Palliative Care
Medicare doesn’t cover one singular “palliative care” benefit. But it does help pay for palliative care specialist appointments and services, like it would any other covered benefit. For the most part, palliative care services are covered under Medicare Part B, which includes outpatient services and medical equipment.
Some Medicare benefits that may fall under palliative care include:
- Physical therapy
- Occupational therapy
- Pain management
- Mental health care
- Home health services
- Rehabilitation services
- Durable medical equipment
If you’d like to pursue palliative care, first speak with your primary care provider. Medicare only covers medically necessary services, so your doctor needs to certify that you need those services to treat or manage a specific health condition. Your doctor can identify the most beneficial services and provide a referral to a palliative care specialist.
As long as you meet the eligibility requirements and your provider accepts Medicare, you’ll only pay a portion of the cost. For Medicare Part B, this is typically a 20% coinsurance.
Common Conditions for Palliative Care
Palliative care is unique to the individual. It can be adapted to support a variety of health conditions, including the following.
- Cancer
- Dementia
- Alzheimer’s
- Heart failure
- Stroke
- Sickle cell anemia
- Multiple sclerosis
- Kidney disease
- Huntington’s disease
- Liver disease
- Parkinson’s disease
- Chronic obstructive pulmonary disease
How Long Will Medicare Pay for Palliative Care?
Medicare will pay for palliative care as long as it remains medically necessary, or until the person enters hospice care. While hospice care includes palliative care, it’s a distinct benefit with a different cost structure.
At other stages of chronic illness, Medicare pays for palliative care as long as the person’s insurance is active, and they receive care from Medicare-approved providers. Medicare doesn’t limit the number of times someone can get palliative care services like physical therapy, occupational therapy, or counseling. But Medicare also doesn’t have an out-of-pocket maximum, so the person will pay a 20% coinsurance each time.
A few comfort-focused services do have a maximum usage. For example, Medicare covers 12 acupuncture sessions per year to help with chronic back pain.
Does Medicare Cover Palliative Care Medication?
Original Medicare only covers medication that you wouldn’t give yourself. Part A covers pain relief medication during a hospital stay, for example, while Part B pays for outpatient infusions. If you need prescription drugs to manage chronic pain or symptoms, you’ll have to pay out-of-pocket or purchase an additional Part D insurance plan. Part D plans are sold by private insurance companies.
Each plan has its own formulary, or list of covered medications. Part D plans cover a wide range of drugs to treat nearly any health condition, though you might need to get prior authorization or try a lower-cost version of a drug.
However, Medicare Part D doesn’t include over-the-counter medications or pain management solutions.
How Medicare Advantage Covers Palliative Care
Medicare Advantage plans, which are sold by private insurance companies, may cover palliative care differently. These plans can set their own costs and eligibility requirements, but they must cover at least as much as Original Medicare. That means palliative care services, like occupational therapy and pain management, would be included.
However, Medicare Advantage plans usually cover expanded benefits so they might pay for more comprehensive palliative care. It might be easier to qualify for those services, or they might be less expensive. Medicare Advantage Prescription Drug plans include Part D drug coverage under the same plan instead of requiring enrollment in a separate Part D plan for coverage.
Medicare Advantage plans are differentiated by their provider networks. Insurance companies negotiate lower prices with groups of healthcare providers and facilities, meaning you’ll pay less for in-network care. Some plans won’t cover out-of-network care at all. You also might need a referral or prior approval for certain services.
While Medicare Advantage plans have to meet minimum requirements, they vary based on location, plan type, and insurance company. Contact your insurer to understand how it covers palliative care.
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How Much Palliative Care Costs With Medicare
Your total cost for palliative care depends on many factors, including which services you receive, how often you need them, and which insurance plan you have. Original Medicare allows you to get care from any provider that accepts Medicare, while Medicare Advantage plans have different costs for in-network and out-of-network care.
Even if your services are fully covered, though, there are other expenses to consider.
- Premium: You must pay a monthly premium to keep your plan active. Many people qualify for premium-free Part A, but the standard premium for Part B is $185 per month in 2025. Medicare Advantage plans can charge an additional premium.
- Deductible: You must meet your deductible before your plan kicks in. For Part B, you’ll pay $257 before Medicare starts to pay. Medicare Advantage plans can set their own deductibles.
- Copays and coinsurance: When you receive palliative care services, you’ll pay a portion of the cost. You might pay a set dollar amount, called a copay, for a specialist appointment. You may also owe a percentage of the total—typically 20%—for covered services. With Medicare Advantage, you’ll pay a higher percentage for out-of-network care.
- Out-of-pocket maximum: Only Medicare Advantage and Part D plans have out-of-pocket maximums. In 2025, you won’t pay more than $2,000 for prescription drugs and $9,350 for covered healthcare services. After this point, your insurer will pay 100% of covered palliative care services and medications. Some plans have lower maximums, too.
See It In Action
Let’s say you qualify for home health services. Medicare covers part-time or intermittent home health aide care, up to 28 hours per week.
Per-day costs for home health aides vary by location, typically ranging from $150-$300.
If you’d like support 3 days per week, that adds up to $1,800-$3,600 per month.
With Medicare, you wouldn’t pay anything because this care is covered.
Hospice Care with Medicare
Medicare also covers palliative care under hospice care, though the two are distinct. Hospice care supports individuals with terminal conditions. Hospice care follows the following eligibility requirements:
- An individual’s hospice doctor and regular doctor must certify the person has a life expectancy under 6 months.
- The person must accept palliative care instead of treatment.
- The individual must sign a statement confirming their choice.
Hospice care aims to make the individual more comfortable in the last stage of their life, addressing their physical, mental, emotional, and spiritual well-being. An interdisciplinary care team develops a care plan to support the individual and their family members. This often includes pain relief, symptom management, and respite care. Medicare covers in-home and inpatient hospice care.
Putting It All Together
Palliative care offers life-improving services for individuals with chronic conditions. These services include palliative care specialist appointments, home health care, and rehabilitation services. Prescription drugs for symptom management are covered separately under Part D plans.
Original Medicare and Medicare Advantage may cover palliative care differently, with varying costs and eligibility requirements. If you have one or multiple chronic conditions, consider working with a licensed insurance agent or broker to find a plan that covers palliative care.
Sources
- Disease Types and Palliative Care. GetPalliativeCare.org
- Palliative Care Facts and Stats. Center to Advance Palliative Care.
- Pain Management. Medicare.gov
- Mental Health Care (Outpatient). Medicare.gov
- Physical Therapy Services. Medicare.gov
- Occupational Therapy Services. Medicare.gov
- Home Health Services. Medicare.gov
- Hospice Care. Medicare.gov
- Senior In-Home Care Costs. SeniorLiving.org.