Learn About Palliative Care Coverage Options

What Palliative Care Is and How It Differs From Other Medical Care

Palliative care is a type of medical care focused on relieving suffering and improving quality of life for people with serious illnesses. Unlike curative care, which aims to treat and cure a disease, palliative care works alongside other treatments to manage symptoms and help patients feel more comfortable. According to the National Hospice and Palliative Care Organization, about 1.6 million Americans received palliative care services in 2020, a number that continues to grow.

The key difference between palliative care and hospice care is an important distinction many people misunderstand. Palliative care can be provided at any stage of a serious illness, even while a patient is still receiving treatments meant to cure or slow the disease. Hospice care, by contrast, is typically provided when a person is expected to live six months or less and has chosen to stop curative treatments. Both focus on comfort, but they serve different points in a patient's medical journey.

Palliative care teams usually include doctors, nurses, social workers, counselors, and chaplains who work together to address physical symptoms, emotional needs, and spiritual concerns. A patient might receive palliative care for cancer, heart disease, lung disease, kidney failure, Alzheimer's disease, or many other serious conditions. The care can happen in hospitals, clinics, nursing homes, assisted living facilities, or at home.

Common symptoms that palliative care helps manage include pain, shortness of breath, nausea, fatigue, depression, and anxiety. For example, a person undergoing chemotherapy might use palliative care to manage severe nausea and pain during treatment, while continuing to pursue curative options. Another person in the late stages of heart disease might use palliative care to reduce fluid buildup in the lungs and improve breathing without necessarily pursuing aggressive interventions.

Practical Takeaway: Understanding that palliative care focuses on comfort and quality of life—rather than curing disease—helps clarify what types of coverage and services to look for. Ask your doctor whether palliative care might benefit you or a family member, regardless of what stage of illness someone is in.

How Insurance Plans Cover Palliative Care Services

Insurance coverage for palliative care varies widely depending on the type of insurance you have, the insurance company, and the specific plan. Medicare, Medicaid, and private insurance plans each have different rules about what palliative care services they will pay for and how much of the cost they cover.

Medicare coverage includes palliative care in several settings. Part A (hospital insurance) covers palliative care provided in hospitals and skilled nursing facilities. Part B (medical insurance) covers palliative care services provided by doctors and nurse practitioners in clinics and other outpatient settings. Many Medicare Advantage plans (Part C) also include palliative care coverage, though the details depend on the specific plan chosen. Medicare typically does not impose an age limit on palliative care—beneficiaries of any age with Medicare coverage can receive these services.

Medicaid programs vary by state because each state designs its own Medicaid program within federal guidelines. Some states cover palliative care broadly, while others limit coverage to specific settings or diagnoses. For instance, a state Medicaid program might cover palliative care in hospitals and skilled nursing facilities but not in outpatient clinics. A person on Medicaid should contact their state's Medicaid office or review their plan documents to understand what palliative services are covered.

Private insurance plans through employers or purchased individually may or may not include palliative care coverage. Some plans cover it extensively; others do not cover it at all. Coverage decisions often depend on whether the insurance company considers the services medically necessary. Plans that do cover palliative care may require prior authorization—meaning the doctor must get approval from the insurance company before providing services—or may limit the number of visits allowed per year.

Out-of-pocket costs for palliative care vary. Under Medicare, a beneficiary might pay a copay for office visits or coinsurance for hospital stays, similar to other medical services. Medicaid cost-sharing also varies by state and type of service. People with private insurance may face deductibles, copays, or coinsurance depending on their plan.

Practical Takeaway: Review your insurance policy documents or contact your insurance company directly to learn which palliative care services are covered under your specific plan. Ask whether prior authorization is required and what out-of-pocket costs you might face.

Palliative Care in Hospitals and Inpatient Settings

Hospital-based palliative care teams are increasingly common in the United States. According to the Center to Advance Palliative Care, as of 2023, approximately 85% of hospitals with 50 or more beds had a palliative care program, up from 24% in 2000. These programs provide services to patients admitted to the hospital with serious illnesses who need symptom management and comfort-focused care.

When a patient is hospitalized, palliative care might be recommended by any member of the medical team—the primary doctor, a specialist, a nurse, or sometimes the patient or family member can request it. The palliative care team consults with the patient and primary medical team to create a plan that addresses pain, breathing problems, anxiety, depression, and other distressing symptoms. The team also helps patients and families understand their condition and think through treatment choices that match their values and wishes.

Insurance coverage for hospital-based palliative care is typically included in the hospital bill. Medicare Part A covers the cost of palliative care services provided during a hospital stay as part of the overall hospital payment. Private insurance and Medicaid also usually cover these services when the patient is admitted to the hospital, though the extent of coverage depends on the plan. The patient may owe a copay or coinsurance based on their plan's rules for hospital stays, but palliative care itself is not typically billed separately.

Skilled nursing facilities—places where patients go after hospital discharge to recover or receive ongoing care—also provide palliative care in many cases. Medicare Part A covers a limited number of days in a skilled nursing facility following a hospital stay. Palliative care services provided in these facilities are included in the daily rate paid to the facility. Some private insurance and Medicaid plans also cover skilled nursing facility stays with palliative care included.

One challenge in hospital and inpatient settings is that palliative care consultation may not be automatic or well-publicized. Some patients and families do not know it is an option. Hospitals that have palliative care programs usually post information in patient areas or include information in admission paperwork, but this varies. A patient or family member should feel comfortable asking the hospital medical team whether a palliative care consultation would be helpful.

Practical Takeaway: If you or a family member is hospitalized with a serious illness, ask the medical team whether a palliative care consultation is available. These services are usually covered by insurance when provided in a hospital or skilled nursing facility, so cost is typically not a barrier.

Outpatient and Home-Based Palliative Care Coverage

Outpatient palliative care—services provided in clinics, doctor's offices, or at home—is a growing option, though coverage and availability vary more widely than inpatient services. According to data from the National Health Care Quality and Disparities Report, the percentage of Medicare beneficiaries receiving palliative care in outpatient settings has increased, though many areas still have limited availability.

For Medicare beneficiaries, outpatient palliative care provided by a doctor or nurse practitioner is covered under Part B when it is considered medically necessary. The patient typically pays a copay (usually 20% of the approved amount after the annual deductible is met) for each office visit or consultation. Some Medicare Advantage plans include coverage for outpatient palliative care, but the specific coverage rules depend on the individual plan.

Private insurance and Medicaid coverage of outpatient palliative care varies significantly. Some plans cover office visits with palliative care specialists at the same rate as other doctor visits. Others do not cover palliative care services at all, or cover them only in specific circumstances. A person with private insurance should contact their insurance company to ask whether palliative care office visits are covered and what cost-sharing applies.

Home-based palliative care—where doctors, nurses, or other team members visit a patient at home—may be covered differently than office-