Medicare covers palliative care, but the coverage depends on which part of Medicare you have and where you receive the care

Palliative care is medical care focused on relieving pain and symptoms rather than curing illness. It can happen at the same time as treatment aimed at a cure. Medicare Part A covers inpatient palliative care in hospitals and skilled nursing facilities. Medicare Part B covers palliative care visits with your doctor in an office or clinic. If you have a Medicare Advantage plan (Part C), coverage varies by plan — you will need to check your plan documents or call the plan directly.

The key difference from hospice is that palliative care does not require you to stop curative treatment or have a terminal diagnosis. You can receive palliative care for any serious illness — cancer, heart disease, COPD, Alzheimer's — at any stage. Hospice, by contrast, is for people with a diagnosis of six months or less to live and requires stopping curative treatment.

Key Takeaways

  • Medicare Part A covers palliative care when you are admitted to a hospital or skilled nursing facility as an inpatient.
  • Medicare Part B covers office or clinic visits with a doctor for palliative care consultation and management.
  • Medicare Advantage plans (Part C) cover palliative care, but the details vary by plan and you should contact your plan to confirm what is covered.
  • Palliative care teams are often available in hospitals, cancer centers, and some outpatient clinics, and your doctor can refer you.
  • You do not need a terminal diagnosis to receive palliative care under Medicare — it is available for any serious illness.

How Medicare Part A covers inpatient palliative care

If you are admitted to a hospital or skilled nursing facility, palliative care provided during your stay is covered under Part A. This includes consultations with a palliative care team, pain management, symptom relief, and counseling about your goals and preferences. You pay the Part A deductible (which varies by benefit period) and then Medicare covers the rest of the inpatient stay.

Many large hospitals now have palliative care teams on staff. Your doctor can request a consultation while you are in the hospital, and the palliative care team will meet with you to discuss your symptoms, concerns, and what matters most to you. This happens alongside any other treatment you are receiving.

How Medicare Part B covers outpatient palliative care

When you see a doctor in an office, clinic, or hospital outpatient department for palliative care, Part B covers the visit. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. The doctor bills Medicare for the visit, and you receive an Explanation of Benefits showing what was covered.

Not every clinic or doctor's office has a dedicated palliative care specialist. If your primary care doctor or specialist is managing your symptoms and pain, that care is covered under Part B. If you want to see a palliative care specialist, ask your doctor for a referral. Some larger medical centers, cancer centers, and health systems have outpatient palliative care clinics.

What Medicare Advantage plans cover for palliative care

If you have a Medicare Advantage plan (Part C), your plan must cover at least what Original Medicare covers — inpatient and outpatient palliative care. However, many Advantage plans offer additional benefits, such as coverage for palliative care visits at home or expanded access to palliative care specialists.

The details vary widely by plan and by year. Some plans may require a referral before you can see a palliative care specialist. Others may limit the number of visits or require you to use doctors within the plan's network. Call your plan's member services number (on the back of your card) and ask specifically what palliative care services are covered and whether you need a referral.

Palliative care at home and other settings

Medicare does not cover palliative care visits at home under Part B. However, if you are homebound and your doctor orders home health services, a home health agency can provide nursing care, physical therapy, and other services that may include symptom management and pain relief. This is covered under Part A if you were recently discharged from a hospital or skilled nursing facility, or under Part B if your doctor orders it and you meet homebound criteria.

Some Medicare Advantage plans do cover palliative care home visits as an added benefit. If you are interested in receiving palliative care at home, ask your doctor whether home health services would be appropriate, or contact your Advantage plan to ask about this benefit.

How to find a palliative care provider

Start by asking your primary care doctor or your specialist (such as an oncologist or cardiologist) whether palliative care would help with your symptoms. Your doctor can refer you to a palliative care team at a hospital, cancer center, or outpatient clinic. Many doctors are trained in palliative care themselves and can provide symptom management in their own office.

You can also search the Center to Advance Palliative Care website (capc.org), which has a "Find Palliative Care" tool where you can enter your zip code and see programs near you. Not all programs accept all insurance plans, so confirm that they accept Medicare before you schedule an appointment.

The difference between palliative care and hospice under Medicare

Palliative care and hospice are different services covered differently by Medicare. Palliative care is available at any stage of a serious illness and does not require you to stop curative treatment. Hospice is covered under Medicare Part A when a doctor certifies that you have six months or less to live and you choose to focus on comfort rather than cure.

You can receive palliative care while still pursuing chemotherapy, surgery, or other treatments. Hospice typically means stopping those treatments. Some people receive palliative care for months or years; hospice is usually a shorter period at the end of life. Both are covered by Medicare, but the rules and what is included differ significantly.

Frequently Asked Questions

Do I need my doctor's referral to see a palliative care specialist?

Not always. Some outpatient palliative care clinics accept self-referrals, meaning you can call and schedule an appointment without a doctor's order. However, many do require a referral, and your insurance may require one before it will cover the visit. Call the clinic or your insurance plan to ask before you schedule.

Will palliative care cost me more than regular doctor visits?

No. A palliative care visit is covered the same way as any other doctor visit under Medicare Part B — you pay 20 percent of the approved amount after your deductible. Inpatient palliative care during a hospital stay is covered under Part A with no additional cost beyond your Part A deductible.

Can I receive palliative care if I am still getting chemotherapy or other treatment?

Yes. Palliative care is designed to work alongside curative treatment. You can see a palliative care team while you are also receiving chemotherapy, radiation, or other therapies. The palliative care team focuses on managing side effects and symptoms so you feel better during treatment.

What if my Medicare Advantage plan does not cover palliative care?

All Medicare Advantage plans must cover at least what Original Medicare covers, which includes inpatient and outpatient palliative care. If your plan denies coverage for a palliative care visit, you can file an appeal. Contact your plan's member services or ask your doctor's office to help you appeal the decision.

Is palliative care the same as end-of-life care?

No. Palliative care can happen at any point in a serious illness — early on, in the middle, or near the end of life. End-of-life care usually refers to care in the final days or weeks. Hospice is a type of end-of-life care. Palliative care is broader and is not limited to the end of life.