- Working with a palliative care specialist allows people with serious illnesses to maintain their physical, emotional, and spiritual quality of life.
- Medicare covers palliative care as part of treatment for long-term illnesses and hospice care for terminal illnesses.
- Inpatient care, outpatient care, and mental health counseling are just a few of the palliative care services that Medicare covers.
Hospice care and palliative care are two types of services that many Medicare beneficiaries may need in their lifetime. When you have a serious illness, palliative care plays an important role in maintaining your quality of life.
Medicare beneficiaries who choose palliative care are covered under original Medicare or Medicare Advantage.
In this article, we’ll explore what palliative care is, the benefits it can offer, and the specific services Medicare covers.
Palliative care helps improve the physical, mental, social, and spiritual quality of life for those with serious or life threatening illnesses.
When diagnosed with a serious illness, you may choose to receive palliative care in addition to any other ongoing treatments. In this case, palliative care aims to maintain your quality of life throughout your illness.
If you’ve been diagnosed with a terminal illness with less than 6 months to live, you may seek hospice care. In this situation, care centers around providing a good quality of life until the end of life.
People of all ages with serious illnesses can choose palliative care to retain as much of their quality of life as possible. Some of the serious illnesses that may benefit from palliative care include:
- Alzheimer’s disease
- amyotrophic lateral sclerosis (ALS)
- chronic obstructive pulmonary disease (COPD)
- congestive heart failure
- end stage liver disease
- end stage renal disease
- Huntington’s disease
- multiple sclerosis
- Parkinson’s disease
- sickle cell anemia
If you opt to receive palliative care for your illness, the services you receive are based your specific needs. Palliative care services may include:
- pain relief for physical symptoms
- emotional support for mental and spiritual needs
- understanding the treatment options for the illness
- help in making decisions for your treatment and care
- overall support for the illness whether treatment is being sought or not
Palliative care vs. hospice care
While both of these types of care are somewhat similar, there’s a difference between palliative and hospice care:
- Hospice care. This is a type of end-of-life medical care that provides emotional and physical support for patients with terminal illnesses. It is reserved for those with a life expectancy of 6 months or less. Hospice care focuses on relieving the symptoms of the illness, supporting the person’s emotional and spiritual health, and helping with any important decisions regarding the end of life. When you receive hospice care, it takes the place of any curative or life prolonging treatments you would otherwise receive.
- Palliative care. This focuses mainly on improving your well-being if you have a serious illness. Palliative care offers a support system to your and your family so you can continue to have a good quality of life. Unlike hospice care, those receiving palliative care can continue to undergo curative or life prolonging treatments.
Palliative care and hospice care both focus on supporting your overall well-being when you have a serious illness. However, hospice care is reserved for the end of life, when you’ve chosen not to have any further treatments to cure your illness.
Original Medicare and Medicare Advantage both cover palliative care, both with and without hospice care, when it’s deemed medically necessary. Here’s what each part of Medicare covers:
Medicare Part A is hospital insurance. It covers many of the inpatient and skilled care needed with palliative care. Under Part A, you are covered for:
- Inpatient hospital stays. This includes any treatments or services you may need during your stay.
- Short-term stays at a skilled nursing facility. Services include rehabilitation services, medication administration, and other day-to-day care.
- Limited home health care. This includes part-time skilled nursing or home health aide care and rehabilitation services.
- Hospice care. You’re covered for any palliative care necessary for comfort at the end of life.
Medicare Part B is medical insurance. It covers most of the outpatient services that are needed during palliative care. With Part B, you’re covered for:
- Doctor’s appointments. These may be needed for the diagnosis, treatment, and prevention of your illness or other related conditions.
- Durable medical equipment. This includes any equipment that may be needed for treatment or to make you more comfortable.
- Mental health counseling. Emotional support and counseling may be needed for yourself or your loved ones during your care.
- Rehabilitation therapy (as an outpatient). This includes speech therapy, physical therapy, or occupational therapy as needed.
Medicare Part C is also known as Medicare Advantage. This is a Medicare option sold by private insurance companies. With Medicare Advantage, you’re automatically covered for the same services as Medicare Part A and Part B, including those for palliative care.
Under Medicare Advantage, you might also be covered for some additional services, such as:
- Prescription drugs. These may be for treatment or to help ease any symptoms.
- Long-term care. Long-term care may include skilled healthcare services or help with everyday personal needs, such as bathing, dressing, or eating.
Companies that sell Medicare Advantage plans may also offer different plan options to fit individual needs. For people with serious illnesses, Special Needs Plans (SNPs) offer additional medical services and flexibility that may better for long-term or serious conditions.
Medicare Part D is prescription drug coverage. Part D may cover medications needed during palliative care. According to the
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Medications for these conditions may include antidepressants, anxiolytics, antipsychotics, stool softeners, antidiarrheals, and opioid and nonopioid analgesics.
If you are receiving hospice care, most medications are covered under the hospice benefit with a $0 to $5 copayment per prescription drug. Medications that aren’t covered under the hospice benefit may still be covered under a Medicare Part D plan.
You become eligible for Medicare-covered hospice care when you meet all of the following requirements:
- Your regular doctor and hospice doctor certify that you are terminally ill and have 6 months or less to live.
- You choose palliative care for comfort instead of treatments to cure your illness or prolong your life.
- You sign a form stating your choice for hospice care instead of treatment-related care.
When you receive hospice care, your comfort is the most important priority. Many different hospice services are available, based on your end-of-life needs. These may include:
- doctor and nursing services
- medical equipment and supplies
- prescription drugs for symptoms
- physical, occupational, and speech therapy
- grief counseling for you and your family members
- short-term inpatient or respite care
While Medicare generally covers almost everything related to hospice care at no cost, it doesn’t cover living expenses while at home or at another living facility.
When you’re diagnosed with a serious illness, your doctor can help you get in touch with a palliative care specialist. Palliative care specialists help build a team of other specialists to coordinate the many aspects of your care.
Before your appointment with the palliative care specialist, prepare a written list or gather any documents about your illness and related medical history, symptoms, and medications. The palliative care specialist will review this information to create your personalized team and plan.
For example, your palliative care team may include a:
- palliative care doctor
Working together, they may create a plan that involves weekly therapy sessions, a specialized medication plan, and a personalized meal plan. All of these services can help increase your quality of life during your illness or at the end of your life.
If you are receiving palliative care without hospice care, you’ll owe standard Medicare out-of-pocket costs. These costs generally include:
- Premiums. These are usually free for Part A and $144.60 per month for Part B. However, if you have a higher income or need to buy into Part A, you may pay more.
- Deductibles. In 2020, you’ll pay $1,408 per benefit period for Part A and $198 per year for Part B.
- Copayments. These may include out-of-pocket costs for prescription drugs and Medicare Advantage doctor’s visits and specialist visits.
- Coinsurance. Depending on the length of your inpatient care, you may pay some coinsurance costs each day under Part A, 20 percent of the costs for services under Part B, and any costs related to prescription drugs.
If you’re enrolled in a Medicare Advantage plan, you may also owe additional premium, deductible, copayment, and coinsurance costs. These vary by plan, and you can contact your insurer or check your plan documents for specific cost information.
Palliative care is an important part of both treatment-related and end-of-life care that Medicare beneficiaries can and should take advantage of. It can be used along with the treatment of serious illnesses or as a part of hospice care for those at the end of life.
If you are interested in having a palliative care plan created for yourself or a loved one, your doctor can put you in contact with a palliative care specialist in your area.