Does Medicare Cover Palliative Care? 

Medical ailments come in many forms and can affect the whole person in many different ways. While you may think of only the physical changes that take place in the body when dealing with diseases like cancer, the mental, emotional and spiritual health aspects of suffering from a complex disease can be difficult to face as well.

Palliative care is designed to be a treatment option that combines physical, mental, emotional and spiritual support for people who are facing serious and complex disease. This type of care is meant to be comfort care that may or may not contribute to curative intent. People who receive palliative care often receive pain medications, psychological and spiritual counseling as well as other forms of therapeutic care designed to address the specific concerns faced as a result of dealing with a serious and complex medical condition.

What is the difference between palliative care and hospice?

While both palliative care and hospice care are administered as comfort care, meaning they are intended to make life as comfortable as possible for people who are experiencing serious and complex diseases, the two differ in their intent. Hospice care is reserved for individuals who have terminal conditions for which there is no cure or for which there is no intent to seek treatment.

Palliative care is meant for people who are suffering from complex disease conditions with or without curative intent. This means that palliative care is not end-of-life care like hospice, and people who seek out palliative care may end up seeing their conditions improve and or an illness defeated.

Does Medicare cover palliative care?

Original Medicare benefits may cover palliative care in certain situations where this type of care is deemed medically necessary. If you elect to receive palliative care in coordination with your doctor’s recommendations, you can still seek treatment for your medical condition. People who receive comfort care through palliative medicine may transfer to hospice care or may end up stopping palliative care completely depending on the progress of a medical condition.

If palliative care coverage is provided by Medicare, the different parts of the program apply much the same as when Original Medicare benefits are used for traditional medical care. Medicare Part A covers inpatient care for palliative patients who require hospitalization or care in a skilled nursing facility.

Medicare coverage under Part B supplies outpatient benefits for doctor visits and clinical treatment as well as durable medical equipment (DME). Prescription drug coverage is provided by Medicare Part D, but Part D only covers medications purchased from a retail pharmacy. Medications supplied by a hospital facility while receiving inpatient care are covered through Medicare Part A, and clinical administration of medications is covered by Medicare Part B.

Does Medicare cover hospice care?

Original Medicare Part A covers hospice care if Medicare recipients choose to transition to this type of care. In order to receive coverage for hospice care, you will need to elect to forgo curative care. You will also need to sign a statement declaring your desire to stop seeking additional care to treat your medical condition. In most cases, you will also need to have your doctor declare that your prognosis only provides six months or less of life expectancy.

Hospice care under Original Medicare is provided at no cost; however, you may need to pay a nominal fee for prescription medications. If you receive hospice care in a residential facility, you may need to pay for room and board fees as well as a 5% respite care fee.