Is Palliative Care Covered by Medicare?
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Medicare covers palliative care services under its various parts, addressing different aspects like inpatient and outpatient care, prescription drugs and specialized medical equipment. This comprehensive support aims to provide comfort and enhance the well-being of individuals diagnosed with severe or end-of-life ailments. The coverage includes a range of services tailored to the patient's specific needs, from symptom management to mental health support.
Continue reading to find out how Medicare can support you and your family.
What Is Palliative Care?
Palliative care is a specialized medical service dedicated to offering comfort and a sense of control to individuals diagnosed with serious illnesses. Its main objective is to manage both the medical and personal aspects of care in order to reduce suffering and enhance the well-being of the patient.
On the physical side, palliative care may involve treatments that alleviate symptoms of a health condition and facilitate the patient's everyday activities, like personal care and hygiene. In certain situations, it may involve the administration of medication specifically to make the final days of a person’s life as comfortable as possible.
On the mental and emotional spectrum, palliative care can include services like mental health visits for the patient and their family members, especially when a patient has received a challenging diagnosis. This care recognizes and addresses the emotional turmoil and spiritual needs often accompanying serious health conditions.
Palliative care caters to individuals with a variety of health issues, including but not limited to:
Lou Gehrig's disease
Congestive heart failure
Bone marrow transplant
Chronic obstructive pulmonary disease (COPD)
Head and neck Cancer
Eosinophil associated disease (EAD)
Leukemia and lymphoma
Sickle cell anemia
The precise nature of the care provided is tailored to the individual's specific needs and circumstances.
When Does Medicare Cover Palliative Care Services?
Medicare will cover palliative care if treatment falls under inpatient, outpatient and prescription drug services for severe diagnosis or end-of-life ailments. This means Medicare will cover anything deemed "palliative" by your doctor. You may be referred to a palliative care specialist upon diagnosis who will act as a care coordinator and advocate.
In addition, if you’re diagnosed with a terminal illness, Medicare will usually cover palliative care services if you opt for easing your symptoms instead of taking medical treatment. However, palliative care services should still be covered if you continue taking treatment for severe but not terminal conditions.
Does Medicare Cover Palliative Care Services For Dementia?
Part B of Original Medicare covers palliative care for dementia once you've met your Part B deductible of $226. Yearly wellness assessments look for symptoms like memory issues, difficulty concentrating and trouble managing daily activities. Medicare Part B also covers a separate, more comprehensive visit to confirm a diagnosis and establish a care plan.
How Does Medicare Work With Palliative Care?
Medicare Part A
Medicare Part A serves as hospital insurance and offers coverage for inpatient care. It also covers short-term skilled nursing facility stays, which can include rehabilitation and medication management. Home healthcare and hospice care services, essential for end-of-life palliative care, are also covered under Part A as well as durable medical equipment.
Medicare Part B
Part B takes care of outpatient medical services, which include doctor visits for diagnosing and treating illnesses. Like Part A, it also provides coverage for durable medical equipment like wheelchairs. In either case, you pay 20% of the covered equipment.
Part B may also offer mental health support not just for the patient but also for the family. Outpatient rehabilitation therapies such as physical, speech or occupational therapy are also included.
Medicare Part C (Medicare Advantage)
Medicare Part C is administered by private insurance companies and is designed to offer at least the same benefits as Original Medicare. It may also offer added benefits such as coverage for prescription drugs and long-term care. Special needs plans (SNPs) are also available under Part C and are specially designed for individuals with particular needs, such as those with a terminal illness, offering more flexibility and specialized services.
Medicare Part D
Part D of Medicare focuses on prescription drug coverage, which can be vital in palliative care for managing symptoms like pain, nausea or anxiety. Common pain medications will include opioids such as codeine or hydrocodone and helper medications like steroids or tricyclic antidepressants.
How Long Will Medicare Cover Palliative Care?
Medicare does not set a specific duration for coverage when it comes to palliative care; the coverage period aligns with the general rules governing Medicare Parts A, B and D. For example, Part A, which deals with inpatient care, entails both an initial deductible for each benefit period and daily coinsurance charges starting on the 61st day of inpatient care. If inpatient care exceeds 150 days, the patient carries 100% of the cost.
Part B, which handles outpatient treatments, typically covers 80% of the costs after meeting the annual deductible, leaving a 20% coinsurance responsibility for the individual. When it comes to prescription drugs under Part D, standard copayments kick in following the satisfaction of the annual deductible.
Additionally, enrolling in Medigap or Medicare Advantage could influence your out-of-pocket expenses and might offer extra benefits, depending on the specifics of your chosen plan.
What Other Options Do I Have To Pay for Palliative Care?
We've provided a list of other financial options in case you lack the proper coverage for palliative care.
- Medicaid: Coverage for various palliative care services, with eligibility and benefits varying by state. Typically for low-income individuals and families.
- Veterans benefits: Coverage through the Department of Veterans Affairs, including inpatient care, home health services and medications.
- Charitable organizations and nonprofits: HealthWell Foundation, the Leukemia & Lymphoma Society, CancerCare Co-Payment Assistance Foundation and other organizations may provide financial assistance for specific conditions.
- Life insurance "accelerated death benefits": An insurance rider allowing a tax-free advance on life insurance payouts for terminal illnesses.
- Savings and investments: Using personal savings or liquidating investments for care. It is best to consult with a financial advisor for tax purposes.