Medicare covers palliative care, but only in specific settings and under certain conditions

Medicare will pay for palliative care if you receive it as an inpatient in a hospital, as part of a hospice program, or in a skilled nursing facility. The coverage depends on where you are and what type of Medicare you have. Medicare Part A covers inpatient palliative care in hospitals and nursing facilities. If you are enrolled in a Medicare Advantage plan (Part C), your coverage may differ — some plans cover palliative care in outpatient settings that Original Medicare does not.

Palliative care is medical care focused on relieving pain and other symptoms, separate from trying to cure an illness. It can happen at the same time as treatment aimed at a cure. Many people confuse it with hospice, but they are different: hospice is palliative care for people with a terminal diagnosis and a life expectancy of six months or less, while palliative care can start at any point in a serious illness.

Key Takeaways

  • Original Medicare (Part A) covers palliative care when you are admitted to a hospital or skilled nursing facility as an inpatient.
  • Medicare Advantage plans vary in what they cover for outpatient palliative care, so you need to check your plan documents or call your plan directly.
  • Palliative care in a doctor's office or at home is usually not covered by Original Medicare unless it is part of a hospice program.
  • If your doctor believes palliative care is medically necessary, ask them to document that in your medical record before you receive care.

What Original Medicare covers for palliative care

If you have Original Medicare (Part A and Part B), your coverage for palliative care depends on where you receive it. When you are admitted to a hospital as an inpatient, Part A covers the cost of your room, meals, nursing care, and other hospital services — including palliative care services provided by the hospital's doctors, nurses, and specialists. The hospital bills Medicare directly, and you pay your Part A deductible and any coinsurance.

In a skilled nursing facility, Part A also covers palliative care if you are admitted as an inpatient following a hospital stay of at least three days. The facility must be Medicare-certified. Part A covers up to 100 days per benefit period, with you paying nothing for the first 20 days and a daily coinsurance amount for days 21 through 100.

Palliative care in your doctor's office, at home, or in an outpatient clinic is not covered by Original Medicare Part A or Part B, with one exception: if you are enrolled in a Medicare hospice program, palliative care is included as part of that benefit.

How Medicare Advantage plans handle palliative care

Medicare Advantage plans (Part C) are required to cover at least what Original Medicare covers, but many plans offer additional benefits. Some Medicare Advantage plans cover outpatient palliative care visits with a doctor or specialist, either in a clinic or at home. Others may cover palliative care consultations by phone or video. The specifics vary widely from plan to plan and from year to year.

To find out what your Medicare Advantage plan covers, check your plan's Summary of Benefits and Coverage document, which you should have received when you enrolled. You can also call the plan's customer service number — it is on your insurance card — and ask directly whether palliative care is covered in an outpatient setting, and if so, whether you need a referral from your primary care doctor.

Palliative care through Medicare hospice

If you are may be able to access for Medicare hospice, palliative care is a core part of the benefit. You must have a terminal diagnosis with a life expectancy of six months or less, as certified by two doctors. A hospice agency that is Medicare-certified will provide palliative care services including pain management, symptom relief, emotional support, and spiritual care. Medicare Part A covers the full cost of hospice care, and you pay nothing — no deductible, no coinsurance.

Hospice care can be provided at home, in a hospice facility, in a hospital, or in a nursing home. The hospice agency coordinates all your care related to your terminal illness. If you choose hospice, you are saying you want to focus on comfort rather than curative treatment, though you can change your mind and leave the hospice program at any time.

What you need to do before receiving palliative care

Before you receive palliative care, make sure your doctor has documented in your medical record that palliative care is medically necessary for your condition. This documentation helps may support that Medicare will pay for the service. Ask your doctor to be specific about what symptoms or conditions the palliative care will address — for example, pain management, nausea, shortness of breath, or anxiety.

If you are considering palliative care in a setting that Original Medicare does not typically cover (such as an outpatient clinic or at home), contact your insurance plan first to confirm coverage. If you have Original Medicare, ask your doctor whether the palliative care can be provided in a hospital or skilled nursing facility setting where it is covered, or whether you should explore a Medicare Advantage plan that covers outpatient palliative care.

The difference between palliative care and hospice under Medicare

Palliative care and hospice are not the same, and Medicare treats them differently. Palliative care focuses on symptom relief and quality of life and can be used alongside curative treatment at any stage of illness. Hospice is palliative care specifically for people with a terminal diagnosis and a prognosis of six months or less, and it means you have chosen to stop pursuing curative treatment.

Under Medicare, hospice is a fully covered benefit with no cost to you. Palliative care outside of hospice is covered only in inpatient settings (hospital or skilled nursing facility) under Original Medicare. If you want palliative care in an outpatient or home setting, you may need a Medicare Advantage plan that includes that coverage, or you may need to pay out of pocket.

Questions to ask your doctor about palliative care coverage

Before you schedule palliative care, ask your doctor these questions: Where will the palliative care be provided — in a hospital, nursing facility, clinic, or at home? Is the location Medicare-certified? Will my insurance cover it? Do I need a referral? What will my out-of-pocket cost be? Your doctor's office staff can often contact your insurance plan to verify coverage before you receive care, which prevents surprise bills.

If your doctor recommends palliative care in a setting that Original Medicare does not cover, ask whether there are alternative settings where it is covered, or whether your doctor thinks you might be a candidate for hospice. These conversations help you make informed decisions about your care and your costs.

Frequently Asked Questions

Does Medicare cover palliative care at home?

Original Medicare does not cover palliative care at home unless you are enrolled in a Medicare hospice program. Some Medicare Advantage plans do cover home-based palliative care, so check your plan documents or call your plan to ask. If you need symptom relief at home, your doctor may be able to prescribe medications or arrange for other services that Medicare does cover.

Do I need a referral from my doctor to get palliative care?

It depends on your insurance plan and the setting. In a hospital or skilled nursing facility, your doctor typically orders palliative care as part of your inpatient treatment, and no separate referral is needed. For outpatient palliative care through a Medicare Advantage plan, many plans require a referral from your primary care doctor. Call your plan to confirm what is required before you schedule an appointment.

Can I get palliative care and curative treatment at the same time?

Yes. Palliative care is designed to relieve symptoms and improve quality of life while you continue other medical treatment. It is not the same as hospice, which means you have chosen to focus on comfort rather than cure. You can receive palliative care in a hospital or nursing facility while also receiving treatment aimed at your underlying illness.

What if my doctor says I need palliative care but my insurance won't cover it?

Ask your doctor whether the palliative care can be provided in a hospital or skilled nursing facility setting, where Original Medicare covers it. If not, ask your insurance plan whether there is an appeal process or whether they will make an exception. You can also contact your State Health Insurance information Program (SHIP) for free help understanding your coverage options.

Is palliative care the same as hospice?

No. Palliative care relieves symptoms and improves quality of life at any stage of illness, often alongside curative treatment. Hospice is palliative care for people with a terminal diagnosis and a life expectancy of six months or less, and it means focusing on comfort rather than cure. Medicare covers hospice fully; palliative care coverage depends on where you receive it.