Is Palliative Care Covered by Medicare?

Many people wonder if Palliative Care is Covered by Medicare, or how much of it is covered.

What is Palliative Care?

Palliative care is a type of specialized medical care that focuses on easing pain and other symptoms of a serious illness, no matter what the illness is or how far along it is. Palliative care teams try to make it so that both the patients and their families can live better. This kind of care is given in addition to any healing or other care the patient may be getting. A team of doctors, nurses, and other specially trained people give palliative care and work with the patient, their family, and their other doctors to give them more support on top of what they are already getting.

Who is Palliative Care For?

Palliative care can be given to people of any age who have a serious or life-threatening illness. It can help adults and kids who are sick with things like:

  • Cancer
  • Blood and bone marrow disorders requiring stem cell transplant
  • Heart disease
  • Cystic fibrosis
  • Dementia
  • End-stage liver disease
  • Kidney failure
  • Lung disease
  • Parkinson’s disease
  • Stroke

Symptoms that palliative care can help improve include:

  • Pain
  • Nausea or vomiting
  • Anxiety or nervousness
  • Depression or sadness
  • Constipation
  • Difficulty breathing
  • Anorexia
  • Fatigue
  • Trouble sleeping

What to Expect from Palliative Care

Palliative care is a type of care that can be used at any time during a serious illness. It helps you deal with your symptoms and deal with the things that are most important to you. Your first meeting might happen in the hospital or at an outpatient clinic. Research shows that early use of palliative care services can improve the quality of life for people with serious illnesses, reduce depression and anxiety, increase patient and family satisfaction with care, and in some cases even lengthen survival.

Palliative Care Plan

Your palliative care plan is designed to fit your life and needs and it may include things that include but are not limited to:

  • Symptom management
  • Support and advice
  • Care techniques that improve your comfort and sense of well-being
  • Referrals
  • Advance care planning

Palliative Care vs. Hospice Care

Even though palliative care and hospice care are similar in some ways, they are not the same:

  • Hospice care This is a type of care for people nearing the end of their lives that helps them emotionally and physically. It is only for people who are expected to live less than 6 months and it focuses on getting rid of the person’s symptoms, supporting their emotional and spiritual health, and helping them make any important decisions about the end of their life. When you get hospice care, it takes place of any treatments you would get to cure your condition or prolong your life
  • Palliative careThe main goal of this is to help you feel better if you have a serious illness. Palliative care gives you and your family the help you need to keep having a good quality of life. Palliative care is different from hospice care in that people can still get treatments that could cure them or extend their lives

In conclusion, when you have a serious illness, both palliative care and hospice care are meant to help you feel better overall. But hospice care is only for people who are near the end of their lives and have decided not to try to get better.

What Does Medicare Cover for Palliative Care?

Palliative care, with or without hospice care, is covered by both Original Medicare and Medicare Advantage when it is medically necessary. Below is what each part, A through D, of Medicare covers:

Part A

Part A of Medicare pays for hospital stays. It pays for a lot of the skilled care and inpatient care that is needed for palliative care. You are covered under Part A for:

  • Inpatient hospital stays –  This covers any treatments or services you might need while you’re there
  • Short stays at a nursing home with skilled care –  Some of the services are rehabilitation, giving medications, and other day-to-day care
  • Limited health care at home – This includes skilled nursing care or care from a home health aide on a part-time basis, as well as rehabilitation services
  • Hospice care – You’re covered for any comfort care you might need at the end of your life

Part B

Part B of Medicare is medical insurance and it covers most of the outpatient services that are needed for palliative care. Part B covers the following:

  • Doctor’s appointments –  These may be needed to find out what’s wrong with you, treat it, and keep it from getting worse or spreading to other people
  • Durable medical equipment –  This includes any tools you might need for treatment or to make you feel better
  • Counseling for mental health –  During your care, you or your loved ones might need emotional help and counseling
  • Therapy for recovery as an outpatient –  This could be speech therapy, physical therapy, or occupational therapy, depending on what the patient needs

Part C

Part C of Medicare is also called Medicare Advantage. This is a type of Medicare that private insurance companies sell. With Medicare Advantage, you are automatically covered for the same services as Medicare Parts A and B, including palliative care. Under Medicare Advantage, you may also be covered for some of the following services:

  • Prescription drugs that may be for treatment or to help ease symptoms
  • Long-term care which may include skilled healthcare services or help with everyday personal needs

Part D

Part D of Medicare pays for prescription drugs. Part D may pay for the medicines that are needed for palliative care. The World Health Organization says that the following conditions are often treated with medicine during palliative care:

  • Anorexia
  • Anxiety
  • Constipation
  • Delirium
  • Depression
  • Diarrhea
  • Dyspnea
  • Fatigue
  • Mucus buildup
  • Nausea
  • Pain
  • Vomiting

If you or a loved one are looking for palliative care and have questions about if you qualify or about your insurance coverage details, contact us or give us a call today at 800-563-8680, and we would be happy to set up an appointment with you.

// Replaces the excerpt "Read More" text by a link