Ask the Hospice/Palliative Care Doctor
Does insurance cover palliative care or hospice?
Answer from Dr. Ratner: Hospice is a specific covered benefit in almost every insurance policy, including Medicare and Medicaid. In almost all cases, the eligibility and benefits follow the Medicare rules. Thus, eligibility is generally based upon physicians’ expectation of life expectancy for similar individuals of 6 months or less. Insurers make a daily payment to a hospice program which then covers all hospice related costs. For Medicare, that includes medications.
In contrast, palliative care is rarely a specified insurance benefit. Rather, palliative care services are provided within other benefits. For example, in the hospital or clinic, a palliative care specialist provider may offer services under the medical care benefits. Other team members (e.g. social work, chaplaincy) in such settings are only rarely separately compensated by insurance, but patients should not receive bills for their services. While receiving home health services, a home health agency may offer palliative care services provided by a nurse or social worker covered by the home health benefit.
Hospice programs are allowed to provide limited physician consultation services to people not enrolled in hospice under the Medicare benefits, to assist patients in deciding about end of life issues. This is relatively uncommon, however.
One important aspect of palliative care, advance care planning, is now reimbursed by Medicare and some other insurers to medical practices above and beyond the costs of the typical physician visit. Patients should ask their primary care practices and cancer clinics to assist them with completion of a health care directive, reminding them of the extra reimbursement available for that assistance. The billing code is 99497.