Palliative care is a broad term that covers any kind of care that treats symptoms directly, rather than solely focusing on treating a broader illness or issue. Palliative care is focused on improving quality of life and is normally used alongside other types of care that cure or manage the underlying condition(s) present. Palliative care should be considered when a loved one has pain or other symptoms that interfere with daily living or if they are experiencing depression or other negative emotions due to their illness.
While in-home palliative care may be the best solution for your loved one, it’s understandable that they (and you) may worry about the cost. Learning how and when Medicare will cover palliative care is essential.
Does Medicare cover palliative care at home?
There are layers to Medicare’s coverage of in-home palliative care, so it’s important to learn about what’s covered under each part of Medicare. Note that there may be some stipulations surrounding in-home care coverage. These may include a doctor certifying that your loved one meets certain conditions or that the palliative treatment is being used to help them maintain a certain level of ability and quality of life. Below is a breakdown of each part of Medicare and whether it covers palliative care at home.
Medicare Part A
Medicare Part A is primarily hospital insurance. This means that it will cover things like hospital stays, facility-based hospice and rehabilitation care, and some limited aspects of home health care. Home health care services that may help with palliation of symptoms include physical therapy, skilled nursing care, and social medical services. However, Part A often limits the number of hours of home health care that can be covered.
Medicare Part B
Medicare Part B is medical insurance, which means it covers a much wider range of services than Part A. Part B covers services such as doctor’s appointments (which may involve establishing a palliative care plan), medical equipment for help with activities of daily living or pain relief, mental health counseling, and outpatient rehabilitation services. Palliative care services that are deemed medically necessary will often be covered by Part B.
Medicare Advantage plans
Medicare Advantage plans, or Medicare Part C plans, are purchased through private insurance companies. These plans cover the same services that Parts A and B cover and may cover additional services like prescription medications used to provide relief from symptoms and home health care services. Some Medicare Advantage plans may also cover personal care services, housekeeping services, meal delivery, or companion care.
Medicare Part D
Medicare Part D covers prescription drugs. With an optional Part D plan, many types of medication for symptom relief or for mental health conditions will be covered.
Medigap
Medigap, or supplemental Medicare insurance, helps cover any costs not covered by Original Medicare (Parts A and B). Medigap plans are sold through private insurance companies and cover costs like copayments, coinsurance, and, in some cases, deductibles. This type of plan can only be used as a supplement to Original Medicare, and it cannot be purchased if your loved one has enrolled in a Medicare Advantage plan. So, while it will reduce out-of-pocket costs, it may not cover the palliative services your loved one needs if they aren’t already covered by Medicare Parts A and B.
How long does Medicare cover the costs of palliative care at home?
The length of time that Medicare will cover at-home palliative care depends on a variety of factors. However, if palliative care is being used to ease symptoms of long-term illnesses or conditions, then Medicare will typically cover services as long as they’re medically necessary.
How can one start palliative care?
The process of beginning palliative care usually involves a discussion with your loved one about what support they feel they need. Talking with their primary care doctor is also important. Although medical care and pain relief are aspects of palliative care, it can also involve several other layers of help. In addition to emotional and mental health support, as well as pain or symptom relief, palliative care may also involve guidance on navigating medical expenses, spiritual support, and assistance on making long-term or complex care decisions.
Once you and your loved one have assessed what palliative care services are needed, you can begin to find support and resources. Additionally, ensure that their home is set up to meet their needs. If your loved one has limited mobility, durable medical equipment like a rollator or a wheelchair and modifications like grab bars can help keep them as safe and independent as possible.
What support is available for family caregivers?
Emotional support is important for caregivers as well. It may be beneficial to both you and your loved one to engage home care services that can supplement the care you’re already providing.
Caring for a loved one with a serious medical condition is often a stressful experience, but you’re not alone. Joining AgingCare’s Caregiver Forum will allow you to connect with other caregivers, find answers to common questions, discuss problems, and find a sense of community.
Reviewed by Todd Austin, President and COO of Home Care Pulse.
Sources:
What is Medicare Parts A & B (https://www.medicare.org/what-is-medicare-parts-a-and-b/)
Medicare Part D: Medicare Prescription Drug Coverage (https://www.medicare.org/medicare-part-d-medicare-prescription-drug-coverage/)
What’s Medicare Supplement Insurance (Medigap)? (https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap)