Medicare covers palliative care for as long as your doctor says you need it, with no set time limit

Unlike hospice care, which Medicare covers only when a doctor certifies you have six months or less to live, palliative care has no time restriction. You can receive it for months or years while you are still pursuing curative treatment, managing a chronic illness, or living with a serious condition that causes pain or other symptoms. Medicare Part B pays for palliative care services the same way it pays for other outpatient medical care — as long as a doctor orders them and they are medically necessary.

The length of coverage depends on your condition, your treatment goals, and what your doctor documents in your medical record. If your condition improves, your doctor may reduce or stop palliative services. If it worsens, your doctor can increase them. You do not have to choose between palliative care and other treatments, and switching between them does not reset any clock.

Key Takeaways

  • Medicare covers palliative care indefinitely as long as a doctor orders it and documents that it is medically necessary for your condition.
  • Palliative care can run alongside curative treatment, chemotherapy, surgery, or other medical care without time limits or restrictions.
  • Your coverage continues month to month based on your doctor's orders, not on a predetermined schedule or diagnosis.
  • You pay the same Medicare copays and deductibles for palliative care visits as you would for other outpatient doctor visits.
  • If you later move to hospice care, your palliative care coverage ends and hospice coverage begins under different Medicare rules.

What Medicare considers palliative care

Medicare defines palliative care as medical care focused on relieving suffering and improving quality of life, rather than curing the underlying disease. This includes managing pain, nausea, shortness of breath, fatigue, depression, and other symptoms that come with serious illness. A palliative care team typically includes doctors, nurses, social workers, and sometimes chaplains or counselors.

Palliative care is different from hospice. Hospice is end-of-life care for people expected to die within six months, and Medicare covers it fully with no copays. Palliative care can start at any point in a serious illness — even at diagnosis — and continues as long as the symptoms need managing. You can be on palliative care while still receiving chemotherapy, radiation, surgery, or other treatments aimed at curing or controlling your disease.

How Medicare pays for palliative care visits

When you see a palliative care doctor or specialist, Medicare Part B covers the visit under the same rules as any other outpatient doctor visit. You pay your Part B deductible (if you have not met it for the year) and then 20 percent of the Medicare-approved amount. If the palliative care team includes a nurse, social worker, or other specialist, each visit or service is billed separately, and you pay your normal copay or coinsurance for each.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover the 20 percent coinsurance, and Medicare Advantage plans have their own copay structures. Check your plan documents or call your plan to understand what you will owe for palliative care visits.

Palliative care consultations in a hospital or as part of an inpatient stay are covered under Part A (hospital insurance) if you are admitted. If you receive palliative care in a nursing home or assisted living facility, coverage depends on whether you are a Medicare-covered resident and what services are included in your facility's agreement with Medicare.

When coverage can change or end

Your palliative care coverage continues as long as your doctor orders it and documents in your medical record that it remains medically necessary. If your condition improves significantly and you no longer need symptom management, your doctor may discontinue the orders. If you switch to hospice care, your palliative care coverage ends and hospice coverage takes over under different Medicare rules (hospice is fully covered with no copays, but you must have a six-month prognosis).

If you move to a different state, change doctors, or change Medicare plans, you may need to restart the referral process with your new provider. There is no waiting period or re-qualification, but your new doctor will need to place the order and document the medical necessity.

If you lose Medicare coverage — for example, if you return to work and lose may be able to access — your palliative care coverage ends. If you regain Medicare coverage later, you can restart palliative care with a new doctor's order.

Palliative care in different settings

Medicare covers palliative care in outpatient clinics, your doctor's office, hospitals, nursing homes, and sometimes at home. Coverage rules vary slightly by setting.

Outpatient clinic or doctor's office: Covered under Part B. You pay your deductible and coinsurance.

Hospital inpatient stay: Covered under Part A if you are admitted. Palliative care consultation is included in your hospital stay coverage.

Home health: Covered under Part A if you are homebound and your doctor orders home health services that include palliative care. You pay nothing for home health services covered by Medicare Part A.

Nursing home or assisted living: Coverage depends on your status. If you are a Medicare-covered resident in a skilled nursing facility after a hospital stay, palliative care may be included. If you are a private-pay resident, Medicare does not cover it.

What to ask your doctor about palliative care coverage

Before starting palliative care, ask your doctor these questions to understand what Medicare will cover:

  • Will you order palliative care services, and how often will I need to come in?
  • Will this be billed to Medicare Part B, or will it be part of my hospital or home health care?
  • What will my out-of-pocket cost be for each visit?
  • If my condition changes, how will that affect my coverage?
  • If I move to hospice care later, how will the transition work?

You can also call Medicare directly at 1-800-MEDICARE to ask whether a specific palliative care service or provider is covered under your plan.

Frequently Asked Questions

Can I get palliative care while I am still getting chemotherapy or other cancer treatment?

Yes. Palliative care and curative treatment are not mutually exclusive. You can receive both at the same time. Palliative care manages the side effects and symptoms of your cancer and its treatment, while your oncologist continues with chemotherapy, radiation, or surgery. Medicare covers both.

If I have been on palliative care for two years, will Medicare stop covering it?

No. There is no time limit on palliative care coverage. As long as your doctor orders it and documents that it is medically necessary, Medicare will continue to cover it month after month, year after year.

What happens to my palliative care coverage if I switch to hospice?

Your palliative care coverage ends when you enroll in hospice. Hospice becomes your primary coverage, and it includes all palliative and comfort care services. You cannot be on both palliative care and hospice at the same time under Medicare.

Do I need a referral from my primary care doctor to see a palliative care specialist?

Not always. Some palliative care clinics accept self-referrals, and some require a doctor's order. Call the palliative care clinic or ask your primary care doctor to find out. Either way, Medicare requires a doctor's order for coverage, so your doctor will need to place one before your first visit.

Will I owe more out-of-pocket costs if I see a palliative care doctor outside my Medicare Advantage network?

It depends on your plan. Most Medicare Advantage plans require you to use in-network providers, and out-of-network visits may cost more or not be covered at all. Check your plan documents or call your plan before scheduling an appointment with an out-of-network palliative care provider.