Palliative care at home is medical care and support for someone with a serious illness, brought to the place where they live. A palliative care team, usually a doctor or nurse practitioner, nurses, and a social worker, visits to treat pain and other symptoms, adjust medicines, plan ahead, and support the family. You do not have to be dying to get it, and you can keep all your regular treatment at the same time.
Medicare does cover palliative care, including care in the home, but not as one package. Part B pays for visits from doctors and nurse practitioners, like any other specialist visit, and you usually pay 20% coinsurance. Medicare Advantage, Medicaid, and most private insurance plans also cover palliative care, with their own rules.
What is palliative care at home?
Palliative care is specialized medical care for people living with a serious illness. Its goal is to relieve symptoms and stress and to improve quality of life for the patient and their family. In-home palliative care simply means the team comes to you instead of you going to a clinic or hospital. You can keep any curative treatment your doctors recommend.
That matters for people who find it hard to leave the house. Someone facing serious illnesses such as cancer, advanced heart failure, COPD, kidney disease, dementia, or a neurological illness like Parkinson’s disease or ALS may spend a lot of energy just getting to appointments. Home visits save that energy for living. They also let the team see how things really are at home: the stairs, the bathroom, the pill bottles, and how tired the caregiver looks.
Palliative home care is not the same as hospice care. Hospice is comfort care for the end of life and means stopping curative treatment for the illness. Palliative care has no time limit and no prognosis rule. Our guide to palliative care vs hospice explains the difference in detail.
What in-home palliative care includes
Programs differ, but most home-based palliative care programs offer some mix of the following:
- Symptom management: help with pain, shortness of breath, nausea, constipation, fatigue, poor appetite, anxiety, depression, and trouble sleeping.
- Medication review: checking all medicines together, stopping ones that no longer help, and adjusting doses.
- Care planning: talking about goals, what matters most, and what the person wants if their health gets worse.
- Advance care planning: help with a health care proxy, a living will, or a POLST form, depending on your state.
- Coordination: keeping your other doctors and each health care provider on the same page.
- Emotional support and spiritual care: for patients and their loved ones, sometimes with a chaplain.
- Caregiver support: teaching, practical tips, and connections to community resources.
- Phone support: many programs offer a nurse line, and some are available around the clock.
Visits are usually scheduled, for example every few weeks, with more visits when symptoms flare up. Palliative care at home is not hands-on daily help. The team does not stay for hours to bathe, cook, or watch your loved one. That kind of help comes from home care aides, family, or other programs. Our guide to what a home health aide does explains that side of care.
Who qualifies for in-home palliative care services?
Anyone with a serious illness can get this type of care, at any age and at any stage. You do not need to have a life expectancy of six months or less, and you do not need to stop treatment.
Home-based programs often have their own extra rules, because home visits take more staff time. Common criteria include:
- A serious or advanced illness, such as cancer, heart failure, COPD, kidney disease, liver disease, dementia, or a neurological disease
- Symptoms that are hard to control
- Frequent hospital stays or emergency room visits
- Trouble getting to the doctor’s office
- Living in the program’s service area
- Insurance the program accepts
How to get a referral
Most palliative care programs need a referral from a doctor. Here is how to start:
- Ask the doctor directly. Say something like: “We would like a palliative care referral. Is there a program that visits at home?” You have the right to ask.
- Ask at the hospital. If your loved one is in the hospital, ask to see the palliative care team before discharge. They often know the home programs in your area.
- Call your insurance. Ask whether your plan has a home-based palliative care program or a list of in-network providers.
- Check with local hospices. Many hospice agencies also run a separate palliative care program for people who are not ready for hospice.
- Use a directory. The GetPalliativeCare.org provider directory from the Center to Advance Palliative Care lets you search by location and setting, including home.
Does Medicare cover palliative care?
Yes. Medicare covers palliative care, but there is no single Medicare “palliative care benefit.” Instead, the services are covered piece by piece under the parts of Medicare you already have.
Medicare Part B
Part B covers visits from doctors, nurse practitioners, physician assistants, and clinical social workers who provide palliative care, in the office or at home. You usually pay the Part B deductible and then 20% of the Medicare-approved amount. If you have a Medigap policy or Medicaid, it may pay some or all of that coinsurance.
Part B also covers advance care planning conversations. If you have that talk during your yearly wellness visit, you pay nothing when the provider accepts assignment.
Medicare Part A
If your loved one is in the hospital or a skilled nursing facility after a hospital stay, Part A covers palliative care as part of that stay.
Medicare home health services
If your loved one is homebound and needs skilled care, such as nursing or therapy, Medicare can also pay for visits from a Medicare-certified home health agency. You pay nothing for these covered visits. This is separate from palliative care, but the two often work side by side. Our guide on whether Medicare covers a home health aide explains the homebound rules.
Does Medicare cover palliative care at home?
Yes, in the sense that Medicare pays for the clinician visits at home under Part B, and for skilled home visits if your loved one qualifies. What Medicare does not pay for is ongoing personal care, such as help with bathing, dressing, and meals, when that is the only care needed, or 24-hour care at home.
Medicare Advantage plans
Medicare Advantage plans must cover everything Original Medicare covers, so they cover palliative care visits too. Some plans offer their own home-based palliative care programs, sometimes with extra services. You may need to use in-network providers and get prior approval, and copays vary by plan. Call the number on the member card and ask.
Medicaid and private insurance
Medicaid covers many palliative care services, such as doctor and nurse practitioner visits, but what is covered and how varies by state. Some state Medicaid programs have home and community-based services that pay for personal care and help at home, which can fill gaps that Medicare leaves.
Most private insurance plans cover palliative care the same way they cover other specialist care. Some cover a home-based program, some only cover office or hospital visits. Veterans can ask the VA, which offers palliative care to enrolled veterans.
What is usually not covered
- A caregiver in the home for long hours or around the clock
- Help with bathing, dressing, cooking, or cleaning when that is the only care needed
- Room and board in assisted living or a nursing home
- Out-of-network visits, if your plan has a network
- Your share of costs: deductibles, 20% coinsurance, and plan copays
Many families combine palliative care with paid help at home, family caregiving, and breaks for the main caregiver. If you need more hands, our guide to 24-hour home care explains the options.
What are the downsides of palliative care at home?
Receiving palliative care at home works well for many families, but it has limits. It helps to know them up front:
- The team visits, then leaves. Most of the hands-on care between visits falls to the family.
- Not every area has a home-based program, and some have waiting lists.
- After-hours help may be a phone call, not a visit.
- Coinsurance for regular visits can add up over time.
- Some tests and treatments still mean a trip to the clinic or hospital.
If the level of care your loved one needs grows beyond what you can give, talk with the team about more help at home, a short stay in a facility, or hospice.
How to find a good palliative home care program
When you call a program, ask these questions:
- Do you visit at home in our area, and how often?
- Who will come: a doctor, a nurse practitioner, a nurse, or a social worker?
- Do you take our insurance, and what will we pay per visit?
- How soon can you make the first visit?
- Who do we call at night or on weekends, and will a nurse answer?
- Will you talk with our other doctors?
- What happens if my loved one later needs hospice?
For more general tips on picking a provider, see our guide to finding a home care provider.
How long you can have palliative care at home, and the transition to hospice care
There is no set limit. Palliative care patients can receive care at home for months or years, as long as they need it and the program can serve them. Over time, the illness may progress and treatment may stop helping. When a doctor believes your loved one has about six months or less, and your loved one wants to focus on comfort alone, hospice becomes an option. Hospice covers much more at home under Medicare, including equipment, supplies, symptom drugs, and aide visits. A palliative care team can help you think about that choice and make the handoff smooth.
Checklist: getting started
- Ask your loved one’s doctor for a palliative care referral and name home visits.
- Check your coverage: Original Medicare, Medicare Advantage, Medicaid, or private insurance.
- Ask whether your loved one is homebound and could also get skilled nursing visits at home.
- Make a list of symptoms, medicines, and questions before the first visit.
- Name a health care proxy and write down your loved one’s wishes.
- Save the program’s after-hours number where everyone can find it.
- Plan for the care the program does not provide, such as daily help and caregiver breaks.
- Look after yourself, too. Our guide for family caregivers has practical ideas.
