Palliative care is a type of comfort care that relieves serious or limiting illness symptoms. If you or a loved one needs palliative care at home, you may be wondering if your insurance will cover it.

In this guide, we’ll explore whether insurance covers palliative care at home, what services are covered, the costs associated with this level of care, and how long insurance will provide coverage. 

Key Takeaways 

• Insurance providers will cover palliative care at home with some limits.
  
  

• Medicare will cover palliative care services that fall under their coverage standards for in-home care.
  
  

• Palliative care is covered for as long as the patient has a serious illness, enters hospice care, or no longer needs palliative care. 

  
  

Does Insurance Cover Palliative Care at Home?

Much like hospice care, insurance providers will cover palliative care at home. This includes government-funded and private medical insurance providers. However, each plan's coverage limits differ.

So, does insurance cover palliative care? Dr. BJ Miller from Mettle Health explains:

“Yes, is the short answer… However, the way it’s billed for is a little tricky. Only doctors and NPs (nurse practitioners) can bill for this, which makes it tricky since there are always different ways to bill… To get in the weeds of the back office, that payment does not cover the chaplain, the social worker, etc.”

Medicare, Medicaid, and private insurance are the top payment providers for palliative care at home. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) covers some comfort care services similar to palliative care. 

However, they do not provide full palliative care coverage at home. The Medicare Special Needs Plan (SNPS) covers some expenses related to palliative care at home. If you’re enrolled with Medicare, we recommend contacting them directly to learn exactly what you’re covered for. 

Medicaid provides insurance coverage for low-income people and generally covers palliative care. However, there may be some limitations. If you receive palliative care as part of a hospice care program, Medicaid may cover the following services: 

• Medical supplies

• Medical appliances 

• Homemaker services 

• Home health aids

• Physical therapy 

• Other medical services needed for the diagnosis 

Insurance coverage through Medicaid differs from state to state, so you’ll need to contact Medicaid directly to find out what you’re covered for. The same goes for private medical insurance, as each plan will have different benefits and limits you need to be aware of, or else you may be left with costly out-of-pocket expenses. 

Keep all this important financial information in the money tabs on Trustworthy. Trustworthy is a family operating system used by families nationwide to store their important documents in one secure location. 

Palliative care is a growing medical industry, and according to the Center to Advance Palliative Care, in 2020, more than 80% of hospitals now have a palliative care team. Palliative care is often offered as part of a hospice care program, even though they’re two separate types of care. To look at whether the average American has the appropriate insurance coverage for this care means we have to examine medical insurance coverage for hospice care. 

The CDC reported a worrisome 7% (25.3 million) of Americans did not have health insurance because of the costs of these insurance plans or medical debt. This means that in 2023, 25.3 million people did not have the appropriate insurance to cover palliative care. 

What Palliative Care Services Are Covered By Insurance?

If you’re enrolled with Medicare, they won’t refer to it as palliative care because it falls under their hospice care programs, but it will still be covered. Medicare will cover palliative care services falling under their coverage standards for in-home care.

In-home services that are covered include:

• Nursing care that is either intermittent or part-time 

• Medical supplies like gloves, bandages or bedpans

• Care received from a home health aid that is either intermittent or part-time 

• Speech-language pathology services

• Physical therapy 

• Occupational therapy  

• Medical social services to help families and loved ones cope with the diagnosis. 

• Injectable osteoporosis drug for women only 

Medicaid also offers coverage for home care as part of their Home and Community-Based Services (HCBS) programs. So, patients enrolled in this program can receive care in their homes or the community. This means the patient can live in any of the following and receive insurance coverage for care: 

• In the home of a family member

• In the home of a caregiver 

• At a board and care home 

• In assisted living 

• In an adult foster care home 

• In a senior living center

The level of coverage provided by Medicaid will differ from state to state. Find your state here to learn more about coverage. Most medical insurance companies cover similar services, with premium plans offering more coverage than others.  

Some things that insurance might not pay for include services like: 

• Prescription or pain medication

• Full-time carer

• Live-in carer

• Home meal deliveries 

• Care with bathing, dressing, and going to the bathroom 

• Homemaker services

• Transport to and from medical appointments  

  
  

How Long Does Insurance Cover Palliative Care at Home?

The length of coverage usually depends on several factors, such as state regulations, the patient’s treatment plan and needs, and the limits outlined in the patient’s medical insurance plan. 

Generally, palliative care is covered for as long as the patient has a serious illness, enters hospice care, or no longer needs it. For example, Medicare has different plans offering differing lengths of coverage. Overall, it will provide coverage for the same length as it does for other care, such as hospice care. Medicare’s hospice coverage works on an unlimited 90-90-60 day recertification process, which works the same for palliative care. 

So, after the initial three months of palliative care, Medicare will provide coverage for another 60-day period after the doctor recertifies your eligibility for the program. There are some limitations to home-care coverage through Medicare. It’s limited to a part-time or intermittent basis only, which means:

• Less than 8 hours a day 

• Less than 28 hours per week 

Medicare will not provide coverage beyond that. However, as long as you still need palliative care and your doctor can report that you do, Medicare will provide coverage for this care.

How Can You Qualify for Insurance Coverage for Palliative Care?

For insurance like Medicare to provide coverage for palliative care at home, you need to meet a number of requirements to qualify. These requirements are pretty similar to the criteria for quality hospice care. 

Palliative care patients must be diagnosed with a life-threatening illness that will need palliative care to help improve the patient’s quality of life. Common illnesses cared for in palliative care include: 

• Cancer

• End-stage liver or renal failure 

• Alzheimer’s disease   

• Parkinson’s disease

• Stroke 

• Dementia 

• Congestive heart failure

• HIV/AIDS 

• Sickle cell anemia

Because Medicare’s palliative care services fall under their hospice care program, patients can also use those qualification requirements for this type of care. 

To qualify for palliative care, you should: 

• Be diagnosed with a serious terminal illness

• Be unable to carry out at least 3 of 6 activities of daily living (eating, dressing, bathing, walking, and continence) 

• Have increased weakness and fatigue (mentally and physically)

• See an overall decline in the condition 

Medicare also requires: 

• A terminal diagnosis 

• Patient must choose to receive palliative care for comfort, not to cure their illness 

• Patient must sign a form stating they chose palliative care over care related to treatment 

Store all your signed forms and medical information with Trustworthy. The helpful share feature lets you choose who can access it, such as family members or your estate planning attorney. 

What Are the Costs of Palliative Care at Home?

Palliative care costs vary depending on your medical insurance provider and specific needs. If you use government-funded medical insurance like Medicare, most of your palliative care expenses are covered. Without any form of medical insurance, palliative care can become quite costly. 

Data from the National Library of Medicine found that in 2020, palliative care at home costs around $117-$400 per day, which can add up fast. 

There are also some limits to insurance coverage that we have already discussed, such as:

• Prescription or pain medication

• Full-time carer

• Live-in carer

• Home meal deliveries

These costs will need to be paid out of pocket, regardless. 

Methods to Pay Out-of-Pocket Costs

What do you do if you cannot afford to pay all the out-of-pocket costs that medical insurance will not cover? 

If your insurance provider does not cover some expenses, you pay them out of your retirement or pension funds. You can also use a 401K, a tax-advantaged pension account or IRA.

If you have money in your health savings account (HSA), you can use it to help cover the additional expenses.

If none of those options work well for you, charity options may be available or if worst comes to worst, you might need to take out a loan.

If you don’t have any of these options, you can also request financial assistance from the hospital or approach a local charity to help cover the costs of these expenses.    

Frequently Asked Questions (FAQs)

Is palliative care free in the US?

Palliative care is mostly covered by government-funded medical insurance providers like Medicare and Medicaid and most private insurance. If a patient does not qualify for these plans, certain local non-profits also offer palliative care for the underprivileged. 

How long before death is palliative care needed?

Palliative care can be started from the moment after a terminal diagnosis. There is no need to reach a certain stage in advancement. 

Why do doctors recommend palliative care?

This type of care is recommended to improve a patient's quality of life and help them manage their symptoms.

What happens with palliative care at home?

Palliative care at home is used to provide a patient with comfort and support. This may include pain relief or even spiritual guidance.