People diagnosed with a serious illness, chronic condition, or terminal illness can potentially pay for necessary palliative care through insurance. Medicare, Medicaid, and private insurance providers are common options for seniors for paying for palliative care. Covered palliative care services and supports vary depending on the type of insurance, the insurance plan, the insurance carrier, and more. It’s a good idea to explore insurance options when a palliative care need arises, as out-of-pocket costs may still exist even with insurance coverage.
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Palliative care is specialized medical care that supports and improves the quality of life of a person with a serious illness or severe chronic condition. Rather than to replace a curative treatment, this type of care is designed to help the patient cope with pain, stress, and symptoms associated with their medical condition.
Patients may continue to receive curative treatments while also receiving palliative care, which is generally available to any patient that qualifies regardless of length of life expectancy. It’s important to note that palliative care is not the same as hospice care, which is given at the end of a patient’s life.
Palliative care may be received in a variety of settings, including:
Yes. Individuals may receive insurance coverage for palliative care through Medicare, Medicaid, or their private insurance.[01]
However, insurance plans vary as to what palliative care services they’ll cover, how much they’ll pay, and where care may be received. For example, Medicare may cover some palliative care at home for qualified beneficiaries. Coverage and copays may also be dependent on your loved one’s unique medical situation.
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Some Medicare plans, as shown below, may cover palliative care costs, hospice care costs, and other associated costs.
| Type of plan | Possible coverage |
|---|---|
| Medicare Part A (Hospital Insurance) | This covers hospice care, which may also include comfort care measures that are similar to palliative care.[02] |
| Medicare Part B (Medical Insurance) | This plan provides health care coverage to people 65+ and those with certain disabilities, and it typically covers palliative care. It can potentially help with the costs of durable medical equipment, hospital beds, and wheelchairs required for palliative care treatment and support.[03] However, this plan has coverage limitations, and copays and deductibles may apply in certain situations. Some types of medically necessary treatments and medications may also not be covered under Medicare Part B.[01] |
| Medicare Part C (Medicare Advantage) | If your loved one has this plan, they’ll likely be able to utilize the hospice coverage from Part A and the durable medical equipment support from Part B.[04] |
| Medicare Part D | This Medicare plan may help seniors pay for medications, such as prescription pain relievers or anti-nausea medications, that are part of palliative care treatment plans.[04] |
| Medicare Special Needs Plans (SNPs) | People with severe or chronic health conditions, such as chronic heart failure, end-stage liver disease, and certain neurologic disorders, may find that expenses related to palliative care can be covered through SNPs.[05] |
Contact Medicare at 800-MEDICARE (800-633-4227) or chat with someone from Medicare online to learn more about coverage for your loved one’s unique situation.
Another government-funded program, Medicaid generally covers palliative care for beneficiaries. It typically provides coverage for low-income people.
Similar to Medicare, Medicaid may not cover all types of palliative care services. Some medications or treatments may not be covered, and your loved one may also have to pay a copay or deductible in some instances.[01]
If your loved one is receiving palliative care services as part of hospice care through Medicaid, they may qualify for the following to be covered: [06]
As a state-administered program, Medicaid may vary from state to state. To learn more about what’s specifically covered, contact the state Medicaid office where your loved one lives.
Most private insurance plans cover palliative care to some degree. However, not all plans include palliative care as a covered service or only partially cover services, treatments, and medications related to palliative care.
Your loved one’s unique medical situation and health issues will play a role in the types of things covered by their private insurance. To learn what’s covered under your loved one’s plan, it’s essential to contact your loved one’s insurance provider before treatment begins.
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In some cases, insurance may cover palliative care at home. You should closely review your loved one’s specific insurance policy to learn if and how palliative care is covered in their plan benefits. Your loved one’s medical care team, a patient advocate, or a social worker may be able to help them identify palliative care resources that can be done at home.
Read more:Who Pays for Palliative Care at Home?
If insurance won’t cover all palliative care costs, your loved one may be able to use the following to help cover expenses:
If your loved one has limited private funds and they don’t qualify for Medicare or Medicaid, they may receive help through sliding scale payment options, or there may be charitable funding options offered by their palliative care program.
Your parent’s medical care team, their social worker, or their financial counselor may also be knowledgeable about other alternative pay options for palliative care.
National Hospice and Palliative Care Organization. (2019). Palliative care or hospice? The right service at the right time for seriously ill individuals.
The Centers for Medicare and Medicaid Services.What Part A covers. Medicare.gov.
The Centers for Medicare and Medicaid Services. Costs. Medicare.gov.
The Centers for Medicare and Medicaid Services. Your Medicare coverage choices. Medicare.gov.
The Centers for Medicare and Medicaid Services. How Medicare special needs plans (SNPs) work. Medicare.gov.
The Centers for Medicare and Medicaid Services. Hospice benefits. Medicaid.gov.
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