When families face a serious illness, they often find themselves overwhelmed not just by medical decisions, but by financial concerns too. The good news is that Medicare does cover palliative care services, though there are details you'll want to know about coverage limits, qualifications, and payment options.

At APEX Health Services, we've been guiding families through these decisions for years, offering comprehensive at-home palliative care services throughout Illinois. Don’t let financial concerns stop your loved one from getting the right care. Let's walk through everything you need to know about Medicare coverage for palliative care, so you can focus on what matters most — comfort and quality time with your loved ones.

What Is Palliative Care? A Different Approach to Managing Serious Illness.

Palliative care is a specialized form of medical care designed to improve the quality of life for individuals living with serious illnesses. Unlike other forms of medical treatment that focus solely on curing disease, palliative care takes a holistic approach to patient wellbeing.

The primary goals of palliative care include:

• Providing relief from pain and uncomfortable symptoms.
• Managing medications for optimal symptom control and comfort.
• Supporting emotional and spiritual well-being.
• Helping patients and families make informed medical decisions.
• Coordinating care among multiple healthcare providers.
• Improving the overall quality of life during treatment.

What sets palliative care apart from other care options is its flexibility. Patients can receive palliative care services while continuing curative treatments, making it suitable for those at any stage of a serious illness. Unlike hospice care, which typically begins when curative treatments end and life expectancy is six months or less, palliative care lets you fight your illness while finding comfort simultaneously.

Medicare Coverage: Which Plans Pay for Palliative Care Services?

When you're dealing with a serious illness, knowing exactly which Medicare plans will help pay for palliative care services can bring invaluable peace of mind. The good news is that Medicare provides coverage through multiple avenues, giving you flexibility in how you receive and pay for these important comfort-focused services. Let's break down each Medicare component and how it contributes to your palliative care coverage.

Original Medicare Coverage

Both Original Medicare (Parts A and B) and Medicare Advantage (Part C) plans cover inpatient care, outpatient care, and mental health counseling as part of palliative care services. However, how Medicare covers these services differs depending on which part of Medicare you're using.

• Medicare Part A (Hospital Insurance) covers palliative care when you're receiving inpatient hospital stays or skilled nursing facility care. This includes pain management, symptom control, and other comfort measures provided during your hospital or facility stay.
• Medicare Part B (Medical Insurance) provides coverage for outpatient palliative care services. With Part B, you're covered for doctor's appointments, durable medical equipment, mental health counseling, and rehabilitation therapy as an outpatient. These services can be received at home, in a doctor's office, or at an outpatient clinic.

Medicare Advantage Plans Offer Extended Benefits

Medicare Advantage plans must provide at least the same coverage as Original Medicare, but Medicare Advantage plans usually cover expanded benefits, so they might pay for more comprehensive palliative care. Many Medicare Advantage plans include:

• Prescription drug coverage (eliminating the need for separate Part D)
• Additional medical services not covered by Original Medicare
• Lower out-of-pocket costs for certain services
• Care coordination programs specifically for serious illness

Private insurance companies offering Medicare Advantage may also provide Special Needs Plans (SNPs) designed specifically for people with chronic conditions, offering even more comprehensive palliative care coverage.

Medicare Part D and Prescription Drugs

Medicare Part D is prescription drug coverage. Part D may cover medications needed during palliative care, such as pain relief medications, anti-nausea drugs, antidepressants, and other medications to manage symptoms. If you're receiving palliative care outside of hospice, you'll need Part D coverage for your prescriptions.

Qualifying for Palliative Care Under Medicare

Unlike hospice care, palliative care doesn't require a terminal diagnosis or specific life expectancy to qualify for Medicare coverage. When a healthcare professional decides that someone would benefit from palliative care, both Original Medicare and Medicare Advantage plans typically cover the costs.

Common conditions that often qualify for palliative care include:

• Cancer and treatment-related side effects
• Heart disease (congestive heart failure, coronary artery disease)
• Lung disease (COPD, emphysema, pulmonary fibrosis)
• Kidney disease and end-stage renal disease (ESRD)
• Neurological conditions (ALS, Parkinson's, multiple sclerosis)
• Alzheimer's disease and other dementias
• Liver disease (cirrhosis, chronic hepatitis)
• Stroke and its complications
• Advanced diabetes with complications
• Any serious illness causing significant symptoms or distress

To start receiving palliative care services covered by Medicare:

• Your doctor must determine that palliative care would benefit your condition.
• The services must be deemed medically necessary.
• You must receive care from Medicare-approved providers.
• Services must be related to your serious illness diagnosis.

There's no requirement to stop curative treatments or accept a terminal prognosis. This flexibility allows patients to receive comfort care while continuing to fight their illness, making palliative care accessible to many more people than hospice care alone.

How Much Will Medicare Pay? Breaking Down Palliative Care Costs

There’s no one-size-fits-all answer. The amount Medicare covers depends on several factors, including which services you receive and where you get them.

In 2025, you'll pay $1,676 per benefit period for Part A and $257 per year for Part B deductibles.

For services covered under Medicare Part B, you'll typically pay 20 percent coinsurance after meeting your deductible. This applies to doctor visits, outpatient services, and medical equipment related to your palliative care.

You won't pay more than $2,000 for prescription drugs and $9,350 for covered healthcare services if you have a Medicare Advantage plan with an out-of-pocket maximum. This provides important financial protection for families facing serious illness.

It's worth noting that Medicare generally pays for all services related to hospice care, but does not cover living expenses if a person is living in their own home or another living facility. When planning for long-term palliative needs, this distinction becomes important.

Duration of Coverage: How Long Medicare Pays for Palliative Care

Unlike hospice benefit periods, palliative care under Medicare doesn't have specific time limits. Usually, it lasts for as long as the patient has a serious illness, until the patient enters hospice care, or until the patient no longer needs or responds to palliative care services.

This open-ended coverage provides important flexibility for patients with chronic illnesses who may need palliative support for months or even years. As long as your doctor continues to certify that the services are medically necessary and related to your serious illness, Medicare will continue to provide coverage.

Suppose your condition progresses and you become eligible for hospice care. In that case, you can transition from palliative care to the Medicare hospice benefit, which provides more comprehensive end-of-life support but requires accepting comfort care instead of curative treatment.

Quick Reference: Medicare Palliative Care Coverage at a Glance

To help you quickly understand what each part of Medicare covers for palliative care, we've created this table summarizing the key benefits and services:

Palliative Care at Home: What Medicare Covers

Many families prefer to receive palliative care services in the comfort of their own homes. Medicare does cover palliative care at home through several different benefit categories.

Under Medicare Part B, covered home-based palliative care services include physician visits, skilled nursing care, and mental health counseling provided in your home. If you qualify for home health services through Medicare, you may also receive:

• Intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Home health aide services

Medicare covers part-time or intermittent home health aide care, up to 28 hours per week. However, your doctor must order this as part of your treatment plan. Medicare-approved providers can deliver pain management, symptom control, and emotional support services directly to your home, helping you stay in familiar surroundings while getting the care you need.

Alternative Payment Options for Palliative Care Services

While Medicare provides substantial coverage for palliative care, you may encounter services or situations where additional payment sources become necessary.

• Private Insurance: Many employer-sponsored and marketplace insurance plans cover palliative care services. If you have coverage through a current or former employer, check your benefits for palliative care coverage that might supplement Medicare.
• Medicaid: For those who qualify based on income and assets, Medicaid can help cover Medicare premiums, deductibles, and coinsurance. Some states also offer additional palliative care benefits through their Medicaid programs.
• Medicare Supplement Insurance (Medigap): Medigap plans may not cover palliative care directly. However, some plans may cover out-of-pocket costs associated with receiving palliative care, including deductibles and coinsurance for Medicare-covered services.
• Veterans Benefits: Veterans may qualify for palliative care through the VA healthcare system, which can provide comprehensive services at little or no cost to eligible veterans.
• Community Resources: Many communities offer charitable programs, sliding-scale payment options, or volunteer services to help families afford palliative care. Your palliative care team can often connect you with these local resources.

Combining these payment options can significantly reduce your financial burden. Many families find that using Medicare as their primary coverage and supplementing with one or more of these alternatives creates a comprehensive safety net.