Does Medicare Cover Palliative Care? 25 Conditions That May Qualify
Key takeaways:
Palliative care aims to improve the quality of life for individuals facing serious health conditions, such as Alzheimer’s disease, cancer, and heart failure. The costs can vary depending on your medical condition and treatment needs.
Medicare covers palliative care if you have a life-threatening illness. But each part of Medicare typically covers different aspects of treatment.
Even with insurance, you may still face out-of-pocket costs such as coinsurance, copays, and deductibles. Medigap and other resources can assist with these costs.
Table of contents
When facing a severe illness, you should be focused on living life comfortably and with dignity. This is where palliative care comes in. It offers relief from pain, symptoms, and stress. If you’re eligible for Medicare, you’ll receive help covering different aspects of your palliative care treatment.
What is palliative care?
Palliative care is a specialized form of medical care. It aims to improve the quality of life for people facing serious health conditions, such as cancer, dementia, and heart failure. Unlike treatments aimed at curing an illness, palliative care focuses on the following:
Managing symptoms
Providing pain relief
Offering emotional support
From initial diagnosis to end of life, palliative care can begin at any stage during an illness. You can also receive palliative care with curative treatments, such as chemotherapy and radiation.
Your palliative care team consists of specialized healthcare professionals, such as physicians and nurses. Depending on your situation, you may have options about where you receive care. Common locations are hospitals, nursing homes, and clinics. Some people even receive palliative care in their homes.
How does palliative care differ from hospice?
Palliative and hospice care both focus on improving the quality of life for people with serious illnesses. But they serve different purposes.
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Hospice care is designed for individuals nearing the end of their life. To qualify for hospice care, you must be terminally ill with a life expectancy of 6 months or less. The goal of hospice care is to provide comfort and support during this final stage. Curative treatments are no longer pursued.
Palliative care, however, can be provided at any stage of a serious illness, with or without hospice care and regardless of the prognosis. This is a holistic approach to care, addressing not only physical symptoms but also emotional, psychological, and social needs.
Which Medicare plans cover palliative care?
Medicare, a government health insurance program for people ages 65 and older or those with certain disabilities, covers many aspects of palliative care as part of hospice care. Palliative care and hospice care share the goal of improving quality of life. But hospice care is designed for people with a terminal illness and a life expectancy of 6 months or less.
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If you qualify for Medicare’s hospice benefits, you can receive palliative care that focuses on symptom relief, emotional support, and comfort. But to receive hospice benefits, individuals must forgo curative treatments. Below is an overview of how the different parts of Medicare apply to these services:
Here’s a breakdown of the different parts of Medicare and what they cover:
Medicare Part A (hospital insurance): You can receive coverage for inpatient stays and palliative care. This is provided under the hospice care benefit.
Medicare Part B (medical insurance): If you are not in hospice, Medicare Part B may cover some palliative care services. These include visits with healthcare professionals and outpatient services that improve quality of life.
Medicare Part C (Medicare Advantage plans): These offer the same benefits as original Medicare. Some plans may offer additional benefits for palliative care.
Medicare Part D (medication coverage): This may cover some prescription medications for palliative care, such as pain medications.
Medicare Supplement Insurance (Medigap): Medigap plans may not cover palliative care directly. But some plans may cover out-of-pocket costs associated with receiving palliative care. This may include deductibles, copays, and coinsurance for Medicare-approved services related to palliative care.
How long will Medicare cover palliative care?
If you receive palliative care as part of Medicare’s hospice benefit, coverage is available for as long as you meet eligibility requirements. Coverage details include:
Two 90-day benefit periods: You are initially eligible for two 90-day periods of hospice care.
Unlimited 60-day benefit periods: After the first 6 months, you can continue receiving hospice care for as many 60-day periods as needed.
Recertification requirement: After the first 6 months, a hospice physician or medical director must recertify that you are terminally ill and that your life expectancy is 6 months or less.
But Medicare coverage for palliative care can differ. It depends on state guidelines, healthcare needs, and the treatment plan. An individual is typically covered as long as the patient has a serious illness. It continues until they transition to hospice care or until palliative care services are no longer needed or effective.
What conditions qualify for palliative care under Medicare?
Nearly half of Medicare beneficiaries have more than three chronic conditions that could be treated with palliative care. If you have any of the following medical conditions, you may benefit from palliative care:
How much does palliative care cost?
One study estimates the annual cost of a palliative care team at $6,500. But that may not include treatment costs. The amount you pay for palliative care will depend on several factors, including:
Medical condition and treatment needs
Setting where care is received, such as a hospital, a nursing home, or your home
Number and types of healthcare professionals providing care
Insurance coverage
Length of time that care is needed
Here are some average daily costs for palliative care without insurance based on the care setting:
| Care setting | Cost per day |
|---|---|
| Routine home care |
|
| Continuous home care | $1,432.41 for 24-hour care |
| Short-term inpatient care | $1,045.66 |
| Inpatient respite care | $461.09 |
What costs should you expect for palliative care under Medicare?
Medicare typically covers most palliative care services, even if they’re not part of end-of-life hospice care. There may be requirements to qualify for coverage. And you could incur out-of-pocket expenses depending on your condition and the care you need. Below are some costs to consider under different parts of Medicare:
Medicare Part A: Inpatient palliative care services, including hospital stays and hospice care, are covered under Medicare Part A. For inpatient hospital stays, you’ll need to pay a deductible each benefit period. After 60 days, daily coinsurance applies, increasing after 90 days. For hospice care, most services are covered in full. But you may pay up to $5 per prescription for pain or symptom relief medications and 5% coinsurance for inpatient respite care.
Medicare Part B: Outpatient palliative care services — such as physician visits, counseling, and certain therapies to improve quality of life — may be covered under Medicare Part B. This is the case if you are not in hospice. You’ll need to meet the Part B deductible (i.e., $257 in 2025) before coverage begins. Then you’ll be responsible for coinsurance. These are the expenses you pay after you meet your health insurance deductible. If Medicare pays 80% of approved palliative care expenses, then your coinsurance is 20%.
Medicare Part C: Medicare Advantage plans include all the benefits of Part A and Part B. They may offer additional palliative care coverage. Costs will vary depending on your plan. But you may have lower copays or coinsurance for visits with healthcare professionals and medications. Review your plan for coverage details and out-of-pocket costs.
Medicare Part D: If you need medications for palliative care, such as pain management, Part D may help with the cost. You may have copays or coinsurance for prescriptions, depending on your plan’s formulary and drug tiers.
If you have palliative care expenses that Medicare or Medigap doesn’t cover, other resources may help you. These include:
Medicaid (dually eligible individuals program with Medicare)
Churches
Frequently asked questions
Yes, Medicare covers palliative care at home if you meet specific requirements. This is part of the hospice care benefit. You must be enrolled in Medicare Part A and have a terminal illness with a life expectancy of less than 6 months. You must also agree to comfort-focused care instead of curative treatments. Care should be provided by a Medicare-approved hospice team. This includes medical services, pain and symptom management, and counseling.
Yes, Medicare covers palliative care in a nursing home if you qualify for the hospice benefit. You must have Medicare Part A, have a terminal illness with a life expectancy of 6 months or less, and choose comfort care instead of curative treatments.
Medicare covers palliative care services provided by the hospice team, but it typically does not pay for room and board costs in the nursing home. Those living expenses may be covered. The hospice team would arrange for short-term inpatient or respite care. A hospice representative will work with the nursing home staff to coordinate care.
Yes, Medicare may cover palliative care services in assisted living. This falls under your hospice care benefits. You must meet hospice eligibility requirements. You also have to agree to comfort measures instead of curative treatments. But Medicare does not cover room and board costs in assisted living facilities. If short-term inpatient or respite care is needed and arranged by the hospice team, Medicare may cover those costs. The hospice team will coordinate with the assisted living staff to provide the necessary care.
The bottom line
Palliative care can offer relief from pain, symptoms, and stress if you have a serious medical condition. If you have Medicare, coverage for palliative care is part of your hospice benefits. But your exact coverage will depend on your Medicare plan and the type of treatment you need. Even with insurance, you could face out-of-pocket costs such as coinsurance, copays, and deductibles. For costs that Medicare and Medigap don’t cover, you may find help through other resources, like charitable organizations or foundations.
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References
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The Henry J. Kaiser Family Foundation. (2015). 10 FAQs: Medicare’s role in end-of-life care.
Medicare.gov. (n.d.). Hospice care. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Pain management. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). What’s Medicare supplement insurance (Medigap)? Centers for Medicare & Medicaid Services.
MedlinePlus. (2024). Palliative care.
National Institute on Aging. (2021). What are palliative care and hospice care? National Institutes of Health.
Reed, S. M., et al. (2022). Modeling of an alternative reimbursement method for palliative care. The American Journal of Managed Care.
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