Palliative care is a type of health care that provides comfort and symptom management for people with a serious illness that may or may not be imminently terminal. For these patients and their families, medical bills can add up fast. Many people rely on health insurance and other benefit programs to cover the cost of at-home palliative care.
However, insurance policies can differ greatly, and there may be copays or other fees involved. Learn what coverage options are available, and talk with insurance providers to determine what services will be covered.
Does insurance cover palliative care at home?
Yes, both public and private health insurance plans can cover part — if not all — of palliative care services. But coverage and costs can vary depending on the services a patient needs, their insurance plan, and where they’re receiving care. Contact your loved one’s insurance provider to determine exactly what services are covered. Their palliative care team may also have insights into coverage options and other ways to reduce out-of-pocket health care expenses.
Medicaid and Medicare
Government-funded insurance programs such as Medicaid and Medicare help cover costs of palliative care at home. Neither Medicare nor Medicaid use the term “palliative” care to describe the services they cover, but the services are actually the same, according to the Center to Advance Palliative Care.
Medicaid is coverage intended for people with low incomes and limited assets, and coverage varies by state. If your loved one is eligible for Medicaid, it can help cover many costs of palliative care services, such as the following:
- Doctor’s appointments
- Skilled nursing care
- Medical social services
- Counseling for both the patient and their family
- Medical equipment and supplies
- Some home health and homemaker services
- Physical, occupational, and speech therapies
Medicare coverage for palliative care at home isn’t as comprehensive as Medicaid’s coverage. But Medicaid can cover costs that Medicare doesn’t cover, if your loved one is eligible for both.
Medicare Part A offers hospice benefits, and Medicare Part B offers some palliative care benefits. The following is a breakdown of how Medicare can help pay for at-home palliative care:
- Medicare Part A primarily covers hospital care, so at-home palliative care coverage can be very limited. It can only pay for palliative care when it’s considered hospice care. In other words, the person has a life expectancy of six months or less, and they’ve chosen palliative care over curative treatment. However, Part A also covers a limited amount of medically necessary home health care and some nonmedical services, which can assist with palliation regardless of whether someone is terminally ill.
- Medicare Part B is medical insurance. It may provide coverage for some medically necessary in-home palliative care services, such as visits from doctors, nurses, and social workers.
- Medicare Advantage plans, also called Medicare Part C plans, cover everything that Parts A and B cover and can include additional coverage for prescriptions, home health care services, and even housekeeping and companion care.
- Medicare Part D only covers prescription medications, which may be used to manage symptoms.
Veterans health benefits
Eligible veterans have access to a range of health benefits through the Veterans Health Administration. Although there may be copays involved, VA health benefits can help cover some palliative care services, which may include the following:
- Comfort care consultations
- Help with defining care goals, decision making, and care coordination
- Follow-ups and check-ins with your loved one’s health care team
- Visits with a primary care physician and/or specialists
TRICARE and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) are both health care programs offered to eligible service members and their families that can help cover the costs of palliative care.
Private health insurance
Many private insurance plans cover at least some palliative care services. Coverage differs from plan to plan and from patient to patient, but can include services like prescription medications, physical therapy, and counseling.
If your loved one has private or employer-sponsored health insurance, contact their insurer to determine if their policy covers at-home palliative care services. Be sure to ask about their eligibility requirements and if there will be any copays or fees.
How do you start palliative care at home?
To start palliative care, whether at home, in a senior living community, or in a hospital setting, your loved one will typically need a referral from their doctor or health care provider. Palliative services can start right away once the doctor gives approval. A patient can request palliative care at any stage of their illness or condition. But the earlier palliative care is initiated, the sooner they can start receiving the support they need.
Before starting care and throughout the process, remember to check in with your loved one about their concerns, goals, and preferences. Involve them in decision making and the development of their care plan to make sure they’re getting the services they want and need most.
Are there barriers to getting home- or community-based palliative care?
There may be restrictions on where a person can receive palliative care. Coverage may vary or be more limited for palliative care received at home versus in a facility or hospital setting, according to the American Cancer Society. If your loved one prefers to receive their care at home, be sure to check with their insurance provider to find out what’s covered and what’s not.
Finding support
If you find you need more than just financial support, consider joining AgingCare’s Caregiver Forum. This online community provides family caregivers a supportive space to connect with other adults navigating care for an aging loved one.
Reviewed by Todd Austin, President and COO of Home Care Pulse.
Sources:
Palliative care is covered under both public and private insurance plans (https://getpalliativecare.org/palliative-care-is-covered-under-both-public-and-private-insurance-plans/)
How and Where Is Palliative Care Provided and How Is It Paid for? (https://www.cancer.org/treatment/treatments-and-side-effects/palliative-care/who-provides-palliative-care.html)