Does Medicare Cover Palliative Care in a Nursing Home?
Navigate Medicare's complex coverage for palliative care in nursing homes, understanding covered services and potential out-of-pocket costs.
Palliative care focuses on providing relief from the symptoms and stress of a serious illness, aiming to improve the quality of life for both patients and their families. This specialized medical care can be integrated at any stage of a serious illness, offering support alongside curative treatments. Medicare, the federal health insurance program in the United States, plays a significant role in covering healthcare expenses for eligible individuals, including those receiving palliative care. This article explores Medicare coverage for these services, especially in a nursing home setting, and related financial considerations.
What Medicare Covers for Palliative Care
Medicare provides coverage for palliative care services when they are deemed medically necessary. Original Medicare (Part A and Part B), along with Medicare Advantage Plans (Part C), cover various aspects of palliative care. Medicare Part A covers inpatient palliative care services, such as those received during hospital stays and short-term skilled nursing facility (SNF) care. It also includes hospice care, which is a specific type of palliative care for individuals with a terminal illness and a life expectancy of six months or less.
Medicare Part B helps cover outpatient palliative care services. This includes physician consultations, certain therapies like physical, occupational, and speech therapy, and medical social services. Durable medical equipment, which may be necessary for comfort or symptom management, can also fall under Part B coverage. Additionally, Medicare Part D, the prescription drug coverage, may cover medications used in palliative care for symptom management, such as pain relief, anti-nausea, or anti-anxiety drugs.
Palliative Care in a Nursing Home Setting
Medicare’s coverage for palliative care in a nursing home primarily applies to skilled nursing facility (SNF) care, not long-term custodial care. For Medicare Part A to cover a stay in a SNF, a patient must first have a qualifying inpatient hospital stay of at least three consecutive days, not counting the day of discharge. The patient must also be admitted to the SNF within 30 days of leaving the hospital and require daily skilled nursing or rehabilitation services for a condition treated during the hospital stay.
Medicare Part A covers the full cost of skilled nursing facility care for the first 20 days in each benefit period. For days 21 through 100 of a SNF stay, a daily coinsurance applies, which is $209.50 in 2025. Beyond 100 days in a benefit period, Medicare Part A generally does not cover SNF costs. It is important to note that Medicare does not cover the cost of long-term custodial care, which includes assistance with daily activities like bathing, dressing, and eating, or the room and board costs in a nursing home when skilled care is not required.
If palliative care is provided in a nursing home as part of Medicare’s hospice benefit, certain conditions apply. Both the patient’s physician and a hospice medical director must certify a terminal illness with a life expectancy of six months or less, and the patient must elect to receive comfort care instead of curative treatment. While hospice care covers nursing services, medications for symptom management, and other supportive services in a nursing home, it generally does not cover the room and board charges for the facility itself.
Accessing Palliative Care and Understanding Costs
To access Medicare-covered palliative care, a physician’s order or referral is typically required, certifying that the services are medically necessary for managing a serious health condition. Patients or their representatives can then work with their healthcare providers to identify Medicare-approved palliative care teams or facilities.
For 2025, the Medicare Part A deductible for each benefit period is $1,676, which applies to inpatient hospital stays and can precede a SNF stay. For services covered under Medicare Part B, beneficiaries must meet an annual deductible, which is $257 in 2025, and then typically pay 20% coinsurance of the Medicare-approved amount for most services. Medications covered by Medicare Part D may involve varying deductibles, co-payments, or co-insurance, depending on the specific plan and the drug’s tier.