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Understanding Palliative Care, and How it’s Covered By Medicare or Your Insurance

Last updated March 18th, 2020

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Comforting the seriously ill is one of the most complex aspects of healthcare. New advances, although welcome, can make the landscape confusing for both patients and caregivers.

One important advance is the growing availability of palliative (pal-lee-a-tive) care. This relatively new medical specialty helps relieve pain, manage symptoms and improve the quality of life for people suffering from a serious illness – whether that illness is curable, chronic or life threatening.

Palliative care is often confused with hospice care (which focuses on managing symptoms and stress during the terminal phase of a serious illness, usually defined as a life expectancy of six months or less). However, palliative care can also comfort those who are not in end-of-life situations.

“Our role is to focus on quality of life,” explained Diana Barnard, a palliative care doctor in Weybridge, Vermont. “How that plays out can be very different for different patients, but we’re here to listen and help figure out what’s best for each individual.”

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Palliative Care vs. Hospices

One way to think of it from the American Academy of Hospice and Palliative Medicine: hospice care is always palliative, but not all palliative care is hospice care.

Unlike hospice, a palliative care patient may continue to seek curative treatment in conjunction with palliative care services. In most cases hospice offers comfort for pain and symptoms only when curative treatments are deemed no longer effective.

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For instance, a patient undergoing chemotherapy for cancer can receive palliative care services to help deal with the side effects and pain associated with those treatments as well as the illness itself, even if a full recovery is expected. Or, a palliative care doctor may help a person with heart failure better deal with the discomfort and inconvenience of heavy doses of diuretics, a common treatment for the disease.

In addition, palliative doctors can arrange for patients and caregivers to connect with support groups and other emotional support systems.

A patient may receive palliative care in any number of medical settings including hospitals, nursing homes, assisted living facilities and home healthcare. You may be referred by your primary doctor treating your illness or meet with someone on staff during a hospital stay. Palliative doctors usually work with a team including a nurse practitioner, social worker and volunteers and they should always work closely with the physicians treating your illness.

Choosing a Doctor: Does Insurance Cover Palliative Care?

Most private health insurance plans and health maintenance organizations cover palliative care services, although some treatments and medicines may not be covered under individual plans.

Medicare Part B and Medicaid also pay for some palliative care, depending on the treatment. Medicare generally doesn’t separate palliative care from the rest of your covered services, so your palliative care provider will be paid like any doctor.

Here are four questions you should ask a potential provider if you’re considering palliative care.

  1. What will you do that’s different from the care I receive from my current doctors? While your doctors focus on treating your illness, your palliative care team should have the training necessary to help with pain management, symptom control and treatment side effects. You also want someone who can help you and your family manage the challenges associated with a serious illness, including decisions about medical treatment, caregiver stress and planning for the future.
  2. How will you coordinate with my current doctors? It’s important to make sure lines of communications are clear from the beginning. For palliative care to work best, your provider needs to work closely with your treating physicians.
  3. Will my insurance cover all of your services? As discussed above, different insurance plans have different coverage of palliative care. You want to make sure your palliative care provider is familiar with your coverage and clear about its possible limits. You’ll also want to check directly with your insurer.
  4. Will my loved ones be involved? One of the main tenets of palliative care is to help inform and support caregivers as well as patients. You want to check that your care team is trained and willing to offer such support.
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