A Guide To Medicare Palliative Care Coverage: Costs, Rules, Help

Palliative care focuses on relieving symptoms and stress of serious illness, and Medicare can help pay for it.

Whether you’re managing heart failure, COPD, dementia, cancer, or another condition, understanding what Medicare covers—and what it doesn’t—can help you get support sooner and avoid surprise bills.

What is palliative care under Medicare?

Palliative care is specialized medical care that treats pain, breathlessness, nausea, anxiety, and other symptoms while supporting you and your family emotionally and spiritually. It can be provided at any stage of a serious illness, alongside treatments meant to cure or control disease. Unlike hospice, palliative care doesn’t require a six‑month prognosis or that you stop curative treatment.

Medicare doesn’t have a single, stand‑alone “palliative care benefit.” Instead, services are covered under existing Parts A and B: hospital and facility care (Part A) and outpatient professional services (Part B). A palliative care team may include physicians, nurse practitioners, nurses, social workers, and other clinicians working with your existing doctors to focus on comfort and quality of life.

What Medicare covers for palliative care

Part B (outpatient) services commonly used

Visits with palliative specialists (physicians and nurse practitioners), primary care clinicians, and relevant specialists for symptom management and care planning.
Advance Care Planning conversations, where you discuss goals, values, and document preferences (e.g., living will, health care proxy). Medicare covers these conversations under Part B; ask your clinician about billing for advance care planning (details here).
Mental health services for coping with serious illness, including clinical social worker and psychologist visits, when medically necessary.
Durable medical equipment (DME) like oxygen equipment, walkers, and hospital beds when ordered by your provider for home use.
Outpatient therapies (physical, occupational, speech) to help with function and safety.

Part A (inpatient and skilled services)

Inpatient hospital care when you need a hospital stay for symptom control or treatment of your underlying illness. Palliative consults during a hospital stay are typically covered.
Skilled nursing facility (SNF) care after a qualifying hospital stay, when skilled nursing or therapy is needed.
Medicare home health services if you’re homebound and require part‑time skilled nursing or therapy. Home health can include nursing visits, therapy, and certain supplies; palliative teams sometimes coordinate alongside home health.

Prescription drugs and supplies

Outside of hospice, medications for symptom relief are typically covered by your Medicare Part D or Medicare Advantage drug plan based on its formulary, prior authorization rules, and copays.
Under the hospice benefit (see below), medications related to the terminal illness are usually provided by the hospice with a small copay per prescription; other unrelated drugs may continue under Part D.

Telehealth options

Many palliative care visits can be done by video or phone when clinically appropriate. Medicare covers a broad range of telehealth services; ask your provider if your visit qualifies (Medicare telehealth coverage).

What it costs: Original Medicare vs. Medicare Advantage

Original Medicare (Parts A & B)

Part B: You usually pay 20% coinsurance of the Medicare‑approved amount for covered outpatient services after the annual Part B deductible. A Medigap (Medicare Supplement) policy, if you have one, may cover some or all of that coinsurance.
Part A: Hospital and SNF costs follow Part A deductibles and daily coinsurance rules, which can apply if you’re admitted. Home health services are generally covered at $0 for eligible episodes, though DME may have coinsurance.
Advance Care Planning: If provided as part of your Annual Wellness Visit, it’s covered without cost‑sharing; otherwise Part B cost‑sharing may apply.

Medicare Advantage (Part C)

Plans must cover at least what Original Medicare covers, but your copays, prior authorization, and provider networks can differ. Check your plan’s Evidence of Coverage for palliative care, specialty visits, DME, and telehealth copays.
Most hospice care is still paid by Original Medicare even if you’re in an Advantage plan; some plans in select areas include hospice through special demonstrations—call your plan to confirm how hospice is handled.

The hospice benefit—how it relates to palliative care

Hospice is specialized palliative care for people with a terminal illness and a life expectancy of six months or less, where the focus is on comfort rather than cure. If you elect hospice, you typically receive comprehensive services (nursing, social work, chaplain, medications, equipment) at $0, with small copays for certain prescriptions and a 5% coinsurance for inpatient respite care. You usually cannot receive curative treatments for the terminal condition while on hospice, but you can still receive treatment for other conditions.

Who is eligible?

Palliative care (non‑hospice): There’s no specific time limit or prognosis requirement. If you have Medicare and your provider deems services medically necessary, Medicare can cover the components (visits, therapies, DME, etc.) under Parts A and B.
Home health–based palliative support: You must meet Medicare home health criteria (homebound and need for intermittent skilled care). Your doctor must order and periodically review a plan of care.
Hospice: Requires certification of a terminal illness with a life expectancy of 6 months or less and election of the hospice benefit.

How to get palliative care started

Talk to your primary doctor or specialist: Ask for a palliative care consult to address symptoms, stress, and goals of care. Request Advance Care Planning during a visit so your preferences are documented (learn what’s covered).
Ask during a hospital stay: If you’re admitted, ask the care team to involve a palliative consult service for symptom control and discharge planning.
Check in-network options: Call your Medicare Advantage plan (or doctor’s office if you have Original Medicare) to confirm participating palliative providers and any prior authorization.
Look for community programs: Many health systems offer home‑based palliative care. You can also search the national directory at GetPalliativeCare.org.
Consider telehealth: If travel is difficult, ask whether some follow‑ups can be done via video or phone (see coverage).

Real‑life example

Mary, 78, has advanced heart failure and COPD. She struggles with shortness of breath and anxiety about flare‑ups. Her cardiologist refers her to a palliative care clinic. Under Part B, she has an evaluation with a palliative physician and nurse practitioner, adjusts her medications, and completes an advance care planning visit to document goals. Home safety is assessed; she receives a prescription for a rollator and a referral to pulmonary rehab. Some visits are done via telehealth to reduce travel burden. Her symptoms improve, emergency visits drop, and her daughter feels more supported. Later, if her illnesses progress and her goals shift fully to comfort, she may consider hospice for more intensive support at home.

FAQs

Can I receive palliative care and continue treatment?

Yes. You can receive palliative care at any stage of illness, while still getting treatments intended to cure or control your condition. Hospice is the option that generally requires focusing on comfort rather than curative treatments for the terminal condition.

Will my religious or emotional needs be supported?

Medicare covers clinical services like physician, nursing, and clinical social work. Many palliative programs also offer spiritual care and counseling; coverage can vary outside of hospice, but these supports are often included when you elect the hospice benefit.

Do I need a referral?

Original Medicare doesn’t require a referral for many specialists, but your clinician’s order helps establish medical necessity and coordinate care. Medicare Advantage plans may require referrals or prior authorization—check your plan.

What documents should I complete?

Consider an advance directive (living will), a durable power of attorney for health care, and a portable DNR or POLST if appropriate. Ask your clinician about an Advance Care Planning visit, which Medicare covers under Part B.

Key takeaways

Medicare palliative care coverage isn’t a single benefit—it’s a bundle of covered services under Parts A and B tailored to relieve symptoms and support you.
Expect Part B coinsurance for outpatient visits; costs differ if you have Medigap or a Medicare Advantage plan.
Hospice is comprehensive, $0‑cost palliative care for people with a six‑month prognosis who choose comfort‑focused care for the terminal illness.
Ask early. A referral to palliative care can improve quality of life, reduce hospitalizations, and help you make care decisions that match your values.