Yes, palliative care is covered by most insurance plans in the United States, including Medicare, Medicaid, and private health insurance. You’ll typically pay the same cost-sharing you would for any other medical service, meaning standard copays, deductibles, and coinsurance apply. The specifics of what’s covered and where you can receive it vary by plan type, so understanding the details can save you from unexpected bills.
What Medicare Covers
Medicare Part B covers palliative care consultations in a doctor’s office, hospital, nursing facility, or your home. You pay your normal Part B cost-sharing, which typically means 20% of the Medicare-approved amount after your annual deductible. Palliative care services billed under Part B include specialist consultations, symptom management, and care coordination.
Medicare Advantage plans may go further. Starting in 2019, the Centers for Medicare and Medicaid Services reinterpreted its rules to allow Medicare Advantage plans to cover home-based palliative care as a supplemental benefit. This specifically applies to members with a terminal illness and a life expectancy longer than six months, filling a gap where traditional Medicare Part A coverage doesn’t reach. Some plans have eliminated copays for these services entirely. Blue Shield of California, for example, has waived co-pays for home-based primary and palliative care programs. If you’re enrolled in a Medicare Advantage plan, it’s worth calling your plan directly to ask whether they offer this supplemental benefit, since not all plans do.
How Medicaid Coverage Varies by State
Medicaid covers palliative care, but the scope of that coverage depends heavily on where you live. Most state Medicaid programs will pay for palliative care delivered in hospitals, skilled nursing facilities, and rehabilitation settings. Community-based palliative care, meaning services delivered in your home or through outpatient visits, is where coverage gets inconsistent.
A handful of states have moved to explicitly cover community-based palliative care. Hawaii became the first state to receive federal approval for a State Plan Amendment covering community palliative care, with implementation guidance released to health plans in April 2025. Maine is legislatively mandated to reimburse palliative care through its Medicaid program. Ohio requires its managed care plans for dually eligible beneficiaries to cover palliative care services. New Jersey passed legislation in 2023 to cover community-based palliative care under Medicaid and is working on federal approval. New York’s Master Plan for Aging includes a proposal to expand Medicaid access to community palliative care, and Texas is considering a similar Medicaid benefit based on recommendations from its Palliative Care Interdisciplinary Advisory Council.
If your state hasn’t established a specific community palliative care benefit, you may still receive coverage for individual services like specialist visits, pain management, and counseling. These are billed under existing Medicaid categories rather than a dedicated palliative care benefit. Contact your state Medicaid office or managed care plan to find out exactly what’s available.
Private Insurance and the ACA
Most private health insurance plans cover palliative care. The Affordable Care Act requires individual and small group market plans to cover ten categories of essential health benefits, including hospitalization, prescription drugs, mental health services, rehabilitative services, and chronic disease management. Palliative care isn’t named as its own essential health benefit category, but the services that make up palliative care, such as specialist consultations, pain medication, mental health support, and rehabilitative therapy, fall squarely within those required categories.
Your out-of-pocket costs depend on your plan’s structure. You’ll pay whatever copay or coinsurance your plan charges for specialist visits, and your deductible applies as it would for any other covered service. If your palliative care team includes social workers, chaplains, or nutritionists, check whether those specific provider types are covered under your plan, since coverage for ancillary providers varies more than coverage for physicians.
VA Benefits for Veterans
Palliative care is part of the VA’s Standard Medical Benefits Package. All enrolled veterans are eligible as long as they meet the clinical need for the service. The VA may charge copays for palliative care, and whether you owe anything depends on your priority group and the type of care received. Veterans already enrolled in VA health care don’t need separate authorization to access palliative care; they can ask their VA care team for a referral.
Palliative Care vs. Hospice: A Key Insurance Distinction
Insurance treats palliative care and hospice care very differently, and understanding the distinction matters for your coverage. Palliative care can begin at the time of diagnosis and run alongside curative treatments. You can receive chemotherapy, surgery, or any other treatment aimed at curing your illness while also getting palliative care for symptom relief. Insurance covers both tracks simultaneously under your plan’s normal benefits.
Hospice is different. When you elect hospice, you stop curative treatment, and Medicare’s hospice benefit (Part A) takes over with its own rules and coverage structure. This is an either/or decision for adults: you receive comfort-focused hospice care, but attempts to cure the illness stop. For children, the rules are more flexible. The Affordable Care Act requires all state Medicaid programs to pay for both curative treatment and hospice services for children and adolescents at the same time, a policy known as concurrent care.
This distinction matters because some people delay palliative care, mistakenly believing it means giving up on treatment. It doesn’t. You can and should pursue palliative care early if you’re dealing with a serious illness, and your insurance will cover it without requiring you to stop any other treatment.
What You Might Pay Out of Pocket
With insurance, your costs for palliative care look like your costs for any specialist visit. Depending on your plan, that typically means a copay of $20 to $75 per visit, plus any applicable deductible or coinsurance for procedures, imaging, or medications prescribed by your palliative care team.
Without insurance, a palliative care doctor visit generally costs between $80 and $170, depending on where you live. States with higher costs of living tend to be at the upper end: Alaska averages $112 to $167, California $103 to $153, and Connecticut $99 to $147. Lower-cost states like Arkansas ($82 to $122) and Alabama ($83 to $123) fall closer to the bottom of the range. These are cash prices for the consultation itself and don’t include medications, lab work, or additional services your care team might order.
Getting Coverage Approved
Palliative care generally doesn’t require prior authorization the way some procedures do, but there are practical steps that smooth the process. Ask your primary care doctor or specialist for a referral to a palliative care team, since many insurance plans require referrals for specialist visits. Confirm that the palliative care providers you’re considering are in your plan’s network, because out-of-network costs can be significantly higher. If you’re receiving home-based palliative care, verify with your insurer that they cover services delivered in the home setting specifically, not just in facilities.
If your insurer denies coverage for a palliative care service, you have the right to appeal. Denials sometimes happen when the insurer doesn’t recognize a service as medically necessary or when billing codes don’t clearly reflect palliative care. Your palliative care team can help with the appeals process by providing documentation of medical necessity.