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What is Palliative Care and Is It Covered by Medicare?

Updated: Jul 21, 2021

There is nothing more important than caring for the well-being of our loved ones. When our spouse or parent becomes seriously ill there is a need for medical support, sometimes above and beyond basic medical treatments and prescriptions.

What is palliative care?

Palliative care is a specialized type of medical care reserved for people who are living with a serious or life-threatening illness. Its purpose is to provide relief from the symptoms and stress of the illness in order to improve quality of life for the patient and their family. In practical terms, palliative care is inpatient care, outpatient care, prescription drugs, and mental health counseling.

Palliative care is provided by a team of doctors, nurses and other specialists who are specially-trained to provide additional care to improve a person’s quality of life alongside the patient’s other doctors. The purpose of palliative care is to meet the needs of the patient, rather than provide curative treatment for the patient’s prognosis. Specifically, it looks to improve the physical, social, mental, and emotional quality of the patient’s life; with care plans built around specific needs.

  • Physical support is all about relieving pain and other symptoms of the illness while helping the person accomplish daily tasks they may be struggling with.

  • Different types of mental healthcare such as grief support and meetings with social workers are provided to support the person’s mental, emotional, and social needs on an ongoing basis.

  • Palliative care providers may even provide support for practical needs such as helping the patient get their finances in order.

  • Palliative care is important for anyone who is suffering from a serious illness but it can be especially helpful for people who are nearing the end of their life.

Does Medicare cover palliative care?

Yes, both Original Medicare and Medicare Advantage Plans cover the cost of palliative care for kupuna who need this type of special support. (Approval is needed by their doctors). Palliative care is covered with or without end-of-life hospice care and may be provided in the person’s home, at a hospital, nursing home, or at a palliative care clinic. In some cases, hospice care is provided instead of palliative care as an alternate type of support for end-of-life care.

Seniors must meet the following conditions to qualify for palliative care in a hospice under Medicare:

  • Both the person’s regular doctor and hospice doctor must certify that the patient is terminally ill and very unlikely to live any longer than six months.

  • The person must sign a form stating that they choose hospice care rather than treatment-related care that would treat their illness or prolong their life.

Which parts of Medicare cover palliative services?

Medicare Part A (hospital insurance) covers inpatient care at a hospital, skilled nursing facility or hospice. This includes treatments and medication during the inpatient stay and skilled nursing care provided by the palliative care team. It also covers limited home healthcare, including part-time skilled nursing and rehabilitation services.

Medicare Part B (medical insurance) covers any doctor visits required for the diagnosis and treatment of the illness or conditions stemming from the illness. It also covers outpatient rehabilitation therapy and durable medical equipment such as wheelchairs, walkers and hospital beds.

Medicare Part C (Medicare Advantage) covers all the same benefits and services as Original Medicare (Parts A & B). In most cases, Medicare Advantage Plans cover additional services, including long-term care to help with personal needs and prescription drugs that can be helpful for easing pain caused by the illness. Patients may also want to look into Special Needs Plans (SNPs) that cater to the needs of specific illnesses. Speak to your Medicare insurance agent to discuss your options.

Medicare Part D (prescription drugs) covers the prescription drugs that a person may need to feel comfortable as they deal with the illness.

Note: most patients will have some out-of-pocket expenses for palliative care including deductibles, copayments and coinsurance. Speak to your plan administrator or Medicare agent to confirm your out-of-pocket responsibilities and to ask if you qualify for financial support through Medicaid or other healthcare programs.

Contact a PBC Agent for Help

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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