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Palliative care is for those with a life-threatening illness. It’s care aimed at improving the quality of life of the patient.
You may receive palliative care in a hospital, nursing home, palliative clinic, or even your home. A common question many people have about this type of care is, “does Medicare cover palliative care?”
In this article, we answer this question in clear, plain English. You will also find the average costs of palliative care.
Does Medicare Cover Palliative Care?
The short answer is yes; Medicare will cover the cost of palliative care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your palliative care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for palliative care. However, Medicare will only cover palliative care if the following conditions are met. Those conditions consist of:
- If the person’s doctor and the hospice doctor diagnose the person with a life-threatening illness and he/she is unlikely to live for longer than 6 months
- The patient must choose to receive palliative care for comfort rather than for treating or curing the condition
- The patient must sign a document that says he/she chooses to receive palliative care rather than treatment-related care.
Hospital and Inpatient Setting
Medicare Part A will provide coverage for palliative care costs if the service is given in a hospital, skilled nursing facility, or an inpatient setting. Medicare Part A will cover the following:
- Inpatient hospital stays along with the treatment and medications that the patient requires
- A short period of stay at a skilled nursing facility along with medications, rehab care, and daily care
- Limited home healthcare which includes part-time skilled nursing or home healthcare and rehabilitation services
- Hospice care that the patient needs at the end of his/her life
At Home or Outpatient Setting
Medicare Part B will cover the cost of palliative care if you receive it outside of hospice care. Medicare Part B will cover the following:
- Visits to the healthcare provider for diagnosis and treatment of the illness
- Durable Medical Equipment (also known as DME)
- Mental health counseling and emotional support for the patient as well as his/her family
- Outpatient rehabilitation care including speech, physical, and/or occupational therapy
Medicare Advantage plans (Medicare Part C) also provides coverage for palliative care as they cover everything Original Medicare covers. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.
There are private insurance companies that partner with Medicare Part C to offer Special Needs Plans (SNPs). SNPs provide additional medical services as well as more versatile services for patients diagnosed with a life-threatening illness.
Medicare Part D
Medicare Part D provides coverage for the prescription medications that the patient needs while he/she is in palliative care. Prescription drugs covered by Medicare Part D may include medications that treat anxiety, pain, nausea, fatigue. Coverage for prescription drugs will be 100% or 95%.
How Much Does Palliative Care Cost?
The cost of palliative care varies based on a number of different factors. But here are some average number to give you an idea of what this type of care costs.
- Routine Home Care For 60 Days – $193
- Continuation of Routine Home Care after the 60th day – $151
- Continuous Home Care – $976
- Inpatient Respite Care – $173
- General Inpatient Care – $744
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Rehab?