Palliative care is a type of care that should be made available to you if you are living with a serious illness. This type of care is focused on making you comfortable, relieving your pain and other symptoms, and helping you manage the stress of being ill.

Palliative care does not aim to cure your illness, though it can be offered in conjunction with curative care. Palliative care focuses on improving your quality of life, no matter what your diagnosis is.

Palliative care can encompass many elements based on your individual needs, wishes, and goals including:

  • Symptom and pain management
  • Connecting you to community resources
  • Advance care planning
  • Assistance navigating your treatment options
  • Comfort measures to boost physical, emotional, and spiritual well-being

Although palliative care is aimed at you as the patient, family and caregivers also benefit as they receive support in the form of information, counseling, and other assistance. Reducing suffering has a positive effect on the physical and mental well-being of you and everyone else involved.

Who Provides Palliative Care?

Palliative care is provided by an interdisciplinary team of trained doctors, nurses, social workers, chaplains, dietitians, and other specialists who work together to manage your treatment and make sure you understand the options available to you.

There are three common palliative care models.

  • Community- and Home-Based Palliative Care: Aimed at tapping into the infrastructure of the local healthcare system to provide better palliative care in a timely manner.
  • Hospital-Based Palliative Care: Palliative care programs provided in a hospital to help improve quality of life for terminally ill inpatients.
  • Telehealth Palliative Care: Allows providers a way to monitor and care for critically ill patients — using different types of communication technologies such as the Internet, telephone, or video conferencing.

Who Pays for Palliative Care?

Because palliative care involves so many elements coming together holistically, the costs may greatly vary from patient to patient.

You may feel the need to  avoid getting certain types of care because they seem costly, especially while you’re still paying for expensive medical treatments.

Below, we’ll take a look at whether or not private insurance covers palliative care and how Medicare and Medicaid may partially or fully cover the cost.

Does Private Health Insurance Cover Palliative Care?

Yes. One of the most common ways to cover palliative care costs is by relying on private insurance. Generally, this medical care is covered either fully or partially by most private health insurance plans.

The coverage is similar to that of other medical or hospital services, but you might have a copay for this care the same way you do for other covered services.

However, more and more health insurance providers also cover community- and home-based palliative care as a supplementary benefit — in fact, the number of health plans offering that is up by roughly 110 percent from 2019.

Each insurance policy is unique and may define palliative care differently. Depending on your policy, it may be considered part of chronic or long-term care or even included under hospice care.

It’s important to read over your insurance terms to learn if your plan places limits on palliative care, as it may limit what kind of illnesses qualify for care and where you can receive this type of care, especially if you’re getting it in the hospital, in rehab, or in a skilled nursing facility instead of within your home.

There may also be additional costs that you must pay out of pocket, like premiums, deductibles, copayment, and coinsurance. For that reason, always check with your insurance company to learn more about what is covered in your policy.

Medicare & Medicaid: Do They Cover Palliative Care?

Like private insurance, government insurance like Medicare and Medicaid also offer coverage options for palliative care, though they usually consider it under hospice care.

Medicaid programs are run by individual states, so coverage for palliative care varies based on where you live.  If you’re eligible for Medicaid, you can find the palliative care coverage details by contacting your state’s Division of Medicaid.  A member of your palliative care team may also be able to assist you in understanding your options.

The different parts of Medicare cover inpatient care, outpatient care, mental health support, and necessary prescription drugs. See below to see which aspects of palliative care are covered by Medicare parts A, B, C, and D.

Medicare Palliative Care Coverage Summary

Part A Inpatient hospital stays, including medication and treatment from palliative care professionals while you are in the hospital
Short-term stays at a skilled nursing facility, including palliative elements of your rehabilitation, medication, and daily care
Limited palliative care at home, including part-time skilled nursing or home healthcare and rehabilitation services
Hospice care, such as end-of-life palliative treatment
Part B Doctor’s visits for the diagnosis and palliative treatment of the illness and related conditions
Durable medical equipment, such as wheelchairs and walkers to help you manage your illness
Mental health counseling and emotional support for you and your family
Outpatient rehabilitation therapy and palliative services, which may include speech, physical, or occupational therapy
Part C (Medicare Advantage) Additional coverage to help with palliative medication and long-term care to help with personal needs
Typically includes Special Needs Plans (SNPs) that offer greater flexibility and may provide more palliative care options
Part D Prescription drugs prescribed as part of a palliative care plan to help with pain and ease symptoms
Source: Medical News Today

If you’re covered by both Medicare and Medicaid, the details can get confusing, and your benefits will depend on your circumstances and location.

Conclusion

Palliative care is a great option if you have a serious, long-term illness. It can help you manage pain, deal with the stress of treatment, and improve your quality of life. Many palliative care options are covered by insurance but each policy is different, so it’s important to learn what your insurance covers. Vynca offers advance care planning and palliative care services to streamline and improve care for those with serious illness.

About the Author

Emelia Altschul

Emelia brings more than 10 years of healthcare marketing and sales experience. Most recently, Emelia led the channel and partnership program at PointRight, a post-acute analytics company.

Prior to that, she spent a number of years at Allscripts, leading marketing for ambulatory solutions and professional services, and was also a client sales executive on the national accounts team. Emelia received her BA from Denison University, and an MBA from Northeastern University with a concentration in marketing.