If a person has a serious illness and is nearing the end of their life, palliative care can be of great help. Medicare covers the cost of palliative care for people who need this special support.
This article will explore palliative care, which parts of Medicare cover it, and the extra emotional and financial support that a person may need.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
When a health professional decides that someone would benefit from palliative care, both original Medicare and Medicare Advantage plans cover the costs.
Medicare covers palliative care with or without end-of-life hospice care.
When someone receives a diagnosis of a life threatening illness, they may need palliative care.
Palliative care doctors and nurses provide treatments that relieve the symptoms of a health condition and improve a person’s quality of life. They may provide care in the individual’s home, a hospital, a nursing home, or a palliative care clinic.
Various conditions may lead to the need for palliative care, including:
- Alzheimer’s disease
- amyotrophic lateral sclerosis
- chronic obstructive pulmonary disease
- congestive heart failure
- end stage liver or renal disease
- Huntington’s disease
- multiple sclerosis
- Parkinson’s disease
- sickle cell anemia
This type of care involves helping improve the physical, mental, and emotional quality of a person’s life. The exact care that someone receives will depend on their individual needs.
Physical support typically involves pain relief for symptoms and in completing everyday tasks that the person may have difficulty with, such as personal care and hygiene.
Palliative care professionals can also provide practical help, such as helping a person navigate treatment options or helping them work out their finances.
Mental healthcare provides support for the person’s emotional and spiritual needs.
Palliative care and hospice care are related forms of support. If someone receives a diagnosis of a terminal illness and a doctor does not believe that they will survive for longer than 6 months, they may choose hospice care.
Hospice care provides the best possible quality of life for someone in their final months of life.
The different parts of Medicare cover inpatient care, outpatient care, mental health support, and necessary prescription drugs.
The following parts of Medicare cover aspects of palliative care.
Medicare Part A
Part A is hospital insurance that covers inpatient care and skilled nursing care that a person may need from palliative care professionals.
Part A covers:
- inpatient hospital stays, including the treatment and medication an individual needs while they are in the hospital
- short-term stays at a skilled nursing facility, including rehabilitation care, medication, and daily care
- limited home healthcare, including part-time skilled nursing or home healthcare and rehabilitation services
- hospice care, such as palliative care that someone needs at the end of their life
Medicare Part B
Part B covers the following:
- doctor’s visits for the diagnosis and treatment of the illness and related conditions
- durable medical equipment, such as wheelchairs and walkers
- mental health counseling and emotional support for the person and their family
- outpatient rehabilitation therapy, which may include speech, physical, or occupational therapy
Medicare Part C
Part C, also known as Medicare Advantage, plans must offer the same benefits and services as original Medicare plans. Part C plans may also cover prescription drugs to help with pain or ease symptoms and long-term care to help with personal needs.
The private insurance companies that administer Medicare Advantage plans typically also offer options such as Special Needs Plans (SNPs).
SNPs provide additional medical services and have greater flexibility that may provide superior options for someone with a terminal illness.
Medicare Part D
Medicare Part D covers prescription drugs, including those a person needs when receiving palliative care.
If someone is receiving hospice care, the hospice benefits will cover the medications, with a $0–5 copay per drug.
If a person receives palliative care, but not hospice care, they will have out-of-pocket expenses to cover. These can include:
If someone receives palliative care and they are not in a hospice, Medicare Part B helps cover the costs.
For Medicare to cover palliative care in a hospice, an individual must meet the following requirements:
- A person’s usual doctor and hospice doctor both must certify that they are terminally ill and are unlikely to live for longer than 6 months.
- An individual must choose to receive palliative care for their comfort rather than treatment to cure their condition or prolong their life.
- A person must sign a form stating that they choose hospice care rather than treatment-related care.
Medicare generally pays for all services related to hospice care, but it does not cover living expenses if a person is in their own home or in another living facility.
There are different support options available for those receiving palliative care. The following sections will look at these options in more detail.
Palliative specialists provide extra support to people with severe illnesses and their loved ones. An individual’s doctor can connect them with a palliative care team that consists of specialists who will coordinate the various factors of care.
Many forms of therapy, including grief counseling, are available through Medicare. This may include weekly therapy sessions.
Palliative care counselors understand the unique challenges that people nearing the end of their life and their families encounter. They provide support to help people process their emotions, which may range from anger to acceptance.
Specially trained professionals support those receiving palliative care with emotional and social issues. These professionals may include social workers and psychologists.
A person may also be able to find support from charities associated with their illness.
If an individual has difficulties covering their out-of-pocket expenses during palliative care, they may be able to find additional support through Medicaid and their hospice benefit or through healthcare programs that agencies such as the Veterans Administration provide.
Palliative care provides comfort to people who have serious illnesses.
Medicare covers palliative care either alongside treatment for the medical condition or as part of end-of-life care for those with terminal illnesses.
Although Medicare covers most of the costs of palliative care, people may still have out-of-pocket costs to pay for their hospital and medical care, along with prescription drugs.
Medicaid, specific charities, and other state-run programs may provide additional support options, ranging from emotional to financial.