Does Medicare Cover Palliative Care?Everything You Need to Know About Palliative Care and How Medicare Can Help Cover You
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According to the World Health Organization (WHO), it is estimated that around 40 million people around the world are in need of palliative care each year. However, only about 14% of people around the world who need palliative care currently receive it.
The majority of adults in need of palliative care have chronic illnesses such as cardiovascular disease, cancer, AIDS, diabetes, and similar conditions.
This article covers the basics of palliative care, why it's important, how it can help you, and how Medicare can provide coverage.
What Is Palliative Care?
Palliative care is an end-of-life type of care that aims to improve the physical, mental, social, and spiritual quality of life for someone who has a terminal or life-threatening disease.
When someone is diagnosed with a terminal illness, receiving palliative care may be an option for them. The patient may combine palliative care with other treatments that they are currently receiving.
In simple terms, palliative care aims to improve the quality of life throughout the stages of a terminal illness.
Like hospice care, palliative care requires that a person be diagnosed with a terminal illness that decreases their life expectancy to less than six months.
Palliative care is available for people of all ages with chronic illnesses who want to maintain their quality of life.
Some of these illnesses include, but are not limited to):
Amyotrophic lateral sclerosis (ALS)
Congestive heart failure
End-stage liver disease
End-stage renal disease
Sickle cell anemia
The exact type of care that a palliative patient receives is dependent on their circumstance.
The patient may receive physical support that aims to relieve the pain of performing everyday tasks, for example, personal care and grooming.
Palliative caregivers can also help with practical issues related to finances, treatment options, and medication administration.
A palliative patient can also receive mental, emotional, and spiritual help through mental health care professionals.
Palliative care services may include:
Pain relief for physical symptoms.
Doctor and nursing care services.
Emotional support for mental and spiritual needs, such as grief or religious counseling.
Explaining available treatment options for illness.
Providing walkers, wheelchairs, catheters, and other equipment designed for comfort or convenience.
Physical or occupational therapy.
What Is Respite Care?
This is when trained providers offer short-term relief to primary caregivers (family or friends) of the terminally ill patient.
It can be arranged for an afternoon, several days, or multiple weeks. Care can be provided at home, in a healthcare facility, or at an adult daycare center.
How Does Palliative Care Work?
Because palliative care prioritizes your comfort during your supposed final six months, many different services are available.
Palliative care can provide a team of professionals who offer the supportive services you need.
A palliative care team may include a:
Each of these specialists can help maintain or increase your quality of living while dealing with your illness.
Before you receive a specialist caring team, you should prepare and gather medical documents related to your illness in order to receive the services you need.
How Does Medicare Cover Palliative Care?
When it is deemed medically necessary, palliative care is covered by both Original Medicare and Medicare Advantage, with and without hospice care.
Here is what each part of Medicare covers:
Medicare Part A is an inpatient hospital insurance that includes palliative care.
If you receive palliative care, Medicare Part A will cover:
Inpatient hospital stays, as well as any services or treatments that you may require during your stay.
A short-term stay at a skilled nursing facility (SNF) which includes rehabilitation services, medication, and other daily care.
Limited home health care that can include part-time skilled nursing care or home health aide care.
Hospice care: If you are covered for hospice care, you also qualify to receive palliative care.
Terms You Should Know
Medically Necessary: Healthcare services or supplies needed to evaluate, diagnose or treat an illness, injury, condition, disease, or its symptoms.
Skilled Nursing Facilities (SNF): A place where people go when they require medical care in cases where, for example, they need to recover from a stroke.
Home Health Aide Care: This provides routine, personal healthcare, such as bathing, dressing, or grooming, to elderly or disabled persons in their own home or in a residential care facility.
Medicare Part B is outpatient medical insurance that will help you with palliative care by covering:
Doctor’s appointments which are needed for the diagnosis and treatment of your chronic illness.
Durable Medical Equipment (DME) that will provide comfort during your treatment and end-of-life stages.
Mental health counseling that can provide emotional and spiritual support for you and your family.
Outpatient rehabilitation therapy which can include speech, physical and occupational therapy.
What Is the Difference Between Outpatient and Inpatient Care?
Inpatient care requires that a patient is admitted to a hospital or a registered healthcare facility, whereas outpatient care does not.
If you receive inpatient care, you will be monitored by a healthcare team in a hospital throughout your treatment and recovery.
Some examples of inpatient care, include:
Serious illnesses that require a patient to be monitored overnight in a hospital.
Outpatient care, also called ambulatory care, does not require hospitalization. For example, a visit to the doctor or counselor is considered an outpatient procedure.
Medicare Part C, more commonly known as Medicare Advantage, is a Medicare solution sold through private insurance companies.
Medicare Advantage plans provide the same coverage as Original Medicare with additional care depending on which policy you buy. Part C can also cover palliative care needs.
Medicare Advantage can cover palliative additional services, such as:
Prescription drugs which can help with your treatment or ease pain caused by your illness.
Long-term care that may include skilled healthcare services to help with everyday tasks that are difficult to complete. These tasks, called activities of daily living (ADLs), include bathing, dressing, and eating.
Medicare Advantage plans can provide you with everything Original Medicare covers, as well as additional, personalized care benefits for your individual needs.
Medicare Part D is responsible for drug coverage. Part D can help provide coverage for medication needed during your palliative care.
Patients may enroll for palliative care due to various illnesses and may require drugs for some of the following:
Palliative Care vs. Hospice Care
Hospice and palliative care are both forms of end-of-life care and are often thought to be the same thing.
However, while both types are similar, there are still key differences between the two.
This type of care is focused on maintaining as much of the patient's well-being as possible during their terminal illness.
Palliative care will offer support structures to ensure that you and your loved ones continue to have a good quality of life before you die.
The difference between palliative care and hospice care is that the former allows the patient receiving care to continue with treatments that are aimed toward extending their life.
For example, a cancer patient undergoing chemotherapy may enroll for palliative care to help them cope with the negative effects of chemotherapy treatment.
Under palliative care, they are allowed to still actively pursue curative treatment, unlike a hospice patient.
How Long Does Medicare Coverage Last for Palliative Care?
Palliative care coverage can last as long as you need hospice care.
To get palliative care you must have a life expectancy of six months or less. If the beneficiary is still alive after six months, hospice and palliative care coverage can continue if the patient re-applies and is re-certified as terminally ill.
Hospice care focuses more on providing emotional, physical, and spiritual support for the terminal patient.
Hospice care is meant for the final stages of your life and does not allow the patient to continue taking life-prolonging treatments.
Hospice care is not curative, but its purpose is to make the final stages of life as comfortable and dignified as possible.
You may only enroll for hospice care if a medical professional has confirmed that your chronic illness has reduced your life expectancy to six months or less.
Am I Eligible for Palliative Care?
Becoming eligible for palliative care will mean meeting the same requirements as hospice care.
Medicare will cover hospice and palliative care if you meet the following requirements:
Hospice and Palliative Care
1. The patient must be enrolled in Original Medicare (Part A and B).
2. The hospice provider must be Medicare-approved.
3. The patient must be certified as terminally ill by a hospice doctor as well as the referring doctor, which means that the patient is only expected to live for six months or less.
Other Hospice Care
4. Hospice care is used for end-of-life comfort and is not an attempt to cure the patient's condition.
5. The patient must sign a statement choosing hospice care over other Medicare benefits aimed at treating the illness.
Where to Learn More about Medicare Coverage?
Palliative care is such an integral part of your final six months.
If you have a terminal illness and are looking for end-of-life care, send your questions to Help@PolicyScout.com or call us at 1-888-912-2132 to get personalized assistance from one of our skilled Medicare consultants.
If you are looking for more information about Original Medicare, Medicare Advantage Plans, or anything Medicare-related, head to PolicyScout’s Medicare hub to compare your options and find the best plan in your area.