Medicare covers palliative care, but only in certain settings and under specific conditions
Medicare pays for palliative care when it is provided as part of a covered service — most commonly through a hospice program, a hospital, or a skilled nursing facility. Palliative care focuses on relieving pain and symptoms rather than curing illness, and it can be given alongside treatment aimed at recovery. The catch is that Medicare's payment rules differ depending on where you receive the care and what type of Medicare coverage you have.
If you are enrolled in Original Medicare (Part A and Part B), you have access to palliative care through hospice at no cost beyond your Part A deductible. If you are in a Medicare Advantage plan, coverage varies by plan — some cover palliative care in hospital or outpatient settings, others do not. Understanding which setting and which plan covers your care is the first step to avoiding surprise bills.
Key Takeaways
- Medicare Part A covers palliative care through hospice programs when a doctor certifies you have six months or less to live, with no out-of-pocket costs beyond the Part A deductible.
- Palliative care in a hospital or skilled nursing facility is covered under Part A if you are already admitted for another reason, but standalone outpatient palliative care visits are not covered by Original Medicare.
- Medicare Advantage plans may cover outpatient palliative care, but coverage depends on your specific plan — you must check your plan documents or call the plan directly.
- You do not have to choose between curative treatment and palliative care; Medicare covers both at the same time if your doctor orders both.
Palliative Care Through Hospice
Hospice is the main way Medicare pays for palliative care. To receive hospice through Medicare Part A, your doctor must certify that you have a terminal illness and six months or less to live. Hospice covers pain medication, symptom management, counseling, and some equipment like hospital beds or oxygen. There is no copay, coinsurance, or deductible for hospice services themselves — you pay only the Part A inpatient hospital deductible if you receive inpatient hospice care in a facility.
Hospice can be delivered at home, in a hospice facility, in a hospital, or in a skilled nursing facility. The hospice team includes doctors, nurses, social workers, and chaplains. Many people choose home hospice because it allows them to stay in their own environment while receiving professional care. Medicare covers up to five days of respite care per stay — inpatient care so that a family caregiver can take a break — at no additional cost.
One important detail: choosing hospice does not mean you must stop all other treatment. You can receive hospice and continue curative treatment at the same time if your doctor believes both are appropriate. However, if you are in a hospice program and want to pursue aggressive treatment instead, you would typically need to leave the hospice program first.
Palliative Care in Hospitals and Skilled Nursing Facilities
If you are admitted to a hospital or skilled nursing facility for another reason — surgery, pneumonia, a fall — and your doctor orders palliative care services while you are there, Medicare Part A covers those services as part of your inpatient stay. This includes pain management, symptom relief, and counseling. You pay your Part A deductible and coinsurance as you normally would for the admission itself.
The key word is "inpatient." If you are admitted to a hospital and receive palliative care consultations from the hospital's palliative care team while you are there, that is covered. If you are discharged and then try to return for outpatient palliative care visits, coverage becomes more complicated and depends on your plan type.
Outpatient Palliative Care and Original Medicare
Original Medicare (Part A and Part B) does not cover standalone outpatient palliative care visits — visits to a doctor's office or clinic for symptom management when you are not admitted to a hospital or facility. This is a significant gap for people who want palliative care support while living at home and continuing other treatments.
Some palliative care may be covered under Part B if it is bundled into another covered service. For example, if you see your primary care doctor and the visit includes pain management and symptom relief, Part B covers the visit as a regular office visit. But a dedicated palliative care consultation at an outpatient clinic is typically not covered by Original Medicare unless you are also receiving hospice.
If you need outpatient palliative care and have Original Medicare, ask your doctor whether the services can be provided during a regular office visit, or whether a home health agency could deliver some services under a Part A home health benefit (which requires a hospital stay or skilled nursing facility stay first).
Palliative Care in Medicare Advantage Plans
Medicare Advantage plans (Part C) set their own coverage rules within Medicare's minimum standards. Some plans cover outpatient palliative care visits; others do not. Some plans cover palliative care only when provided by in-network providers. Coverage also varies by whether the care is deemed "medically necessary" — a term that differs from plan to plan.
The only way to know what your plan covers is to read your plan's coverage document (called the Evidence of Coverage) or call the plan's customer service number. Ask specifically: "Does my plan cover outpatient palliative care visits?" and "If yes, do I need a referral, and what is my copay?" Write down the name of the person you speak with and the date, in case you need to reference the conversation later.
If your Medicare Advantage plan does not cover outpatient palliative care, you have the right to switch to Original Medicare during the annual open enrollment period (October 15 to December 7 each year) or during a Special Enrollment Period if you have a may have access to life event.
What Palliative Care Services Are Covered
When Medicare covers palliative care — through hospice, in a hospital, or through your plan — the covered services typically include:
- Doctor and nurse visits focused on symptom and pain management
- Prescription medications for pain, nausea, shortness of breath, and other symptoms
- Counseling and social work services
- Spiritual care and chaplain services (in hospice)
- Medical equipment such as hospital beds, wheelchairs, and oxygen
- Home health aide services (in some settings)
- Respite care (in hospice)
Services not typically covered include experimental treatments, cosmetic procedures, and long-term custodial care (help with daily activities that is not medically necessary). If you are unsure whether a specific service is covered, ask your provider or your plan before you receive it.
How to Start the Conversation With Your Doctor
Many people wait until very late in an illness to ask about palliative care, but palliative care can start earlier — even while you are still receiving treatment aimed at a cure. You do not need to be dying to benefit from better pain and symptom management.
Start by telling your doctor: "I am interested in palliative care to help manage my symptoms and pain. What options does Medicare cover for me?" Your doctor can then refer you to a palliative care specialist, a hospice program, or a home health agency, depending on what is available in your area and what your insurance covers.
If your doctor seems unfamiliar with palliative care or dismisses the idea, you can ask for a referral to a palliative care specialist directly. Many hospitals have palliative care teams, and some communities have standalone palliative care clinics. Your local Area Agency on Aging can also point you toward palliative care resources in your area.
Frequently Asked Questions
Can I get palliative care if I am not dying?
Yes. Palliative care is for anyone with a serious illness or chronic condition causing pain or difficult symptoms — not just people at the end of life. However, Medicare's main coverage pathway for palliative care is hospice, which does require a six-month prognosis. If you want palliative care but do not meet hospice criteria, check whether your Medicare Advantage plan covers outpatient palliative care, or ask your doctor whether symptom management can be included in your regular office visits.
Do I have to stop cancer treatment or other curative treatment to get palliative care?
No. Palliative care and curative treatment can happen at the same time. You can receive chemotherapy and palliative care together, for example. However, if you enroll in a hospice program, you are typically expected to stop curative treatment — but you can leave hospice at any time if you decide to pursue treatment again.
What if my doctor says I have less than six months to live but I do not want hospice?
You are not required to enroll in hospice even if you meet the criteria. You can decline hospice and instead look for outpatient palliative care through your Medicare Advantage plan, or ask your regular doctor to focus on symptom management during office visits. Some communities also have palliative care programs outside of hospice that may be covered by your plan.
Will palliative care cost me money out of pocket?
Hospice through Medicare Part A has no copay or coinsurance for the palliative care services themselves. Palliative care in a hospital or skilled nursing facility is covered under your Part A benefits, so you pay your normal deductible and coinsurance. Outpatient palliative care coverage and costs depend entirely on your plan — Original Medicare does not cover it, but some Medicare Advantage plans do.
How do I find a palliative care provider near me?
Ask your doctor for a referral to a palliative care specialist or hospice program. You can also contact your local Area Agency on Aging, which maintains lists of palliative care and hospice providers in your area. The National Hospice and Palliative Care Organization has a provider search tool on its website. If you are in a Medicare Advantage plan, call the plan to ask which palliative care providers are in-network.