This article looks at the costs of palliative care and how typical coverage of palliative care services works. It discusses the various personal factors that affect individualized palliative care plans.
What Is Palliative Care?
Palliative care is a holistic approach to comfort care provided by a team of healthcare professionals designed to improve the quality of life for a patient diagnosed with a serious illness. Palliative care can be done alongside a curative treatment plan whereas hospice and end of life care focus on providing comfort during the final and terminal stages of an illness.
Related: What is Palliative Care
How Much Does Palliative Care Cost?
Palliative care costs vary depending on various factors such as: patient’s individual needs and situation, location of care provided, types of providers and personal coverage of insurance plans and policies.
It is important to check with an individual health care plan regarding out of pocket expenses, deductibles, co-pays or other charges in order to get the most accurate costs for individualized palliative care.
According to a study on palliative care for cancer patients,1 palliative care decreased health care costs for a patient after a cancer diagnosis (this varied depending on palliative care models such as inpatient versus at-home care). Palliative care has also shown to decrease hospital costs.
Related: When Should Someone Be Offered Palliative Care
Although individual costs of palliative care are difficult to predict, data shows that patients with access to palliative care have increased satisfaction with care received and reduced medical expenses (like less hospital visits). In the case of a patient with a terminal illness palliative care patient that is homebound with a year left to live, the average cost of care for palliative service was $95.30 per day verses $212.80 for those without palliative care.2
Factors That Impact the Cost of Palliative Care
Palliative care costs depend on many personal situations and factors such as:3
- Environment and region (rural versus city location and access)
- Eligibility criteria (language diversity, enrollment criteria)
- Scope of services needed (complexity of palliative care team)
- Care model (which services make up a team)
- Communication and coordination (presence and frequency of care meetings)
Palliative care may also vary in costs depending on the location of the services provided (hospital, home or a facility), the stage of palliative care (see the 5 stages of palliative care), as well as the level of care that is needed.
How Much Does in-Home Palliative Care Cost?
While in-home palliative care patients’ costs can vary greatly depending on a patient’s condition, hospice and end of life care costs may be a little easier to average. Medicare and many private insurance plans cover hospice. In order for a palliative care patient to be qualified for hospice under Medicare, the patient’s doctor and a medical director for hospice must agree to the patient’s terminal prognosis.
There are various levels of care and costs depending on the medical care and supportive care needed. The following 2021 amounts represent an average out of pocket cost without insurance:4
- Level 1 Routine Home Care (day 1-60): $199 per day (day 61 +): $157 per day.
- Level 2 Continuous Home Care: $59.68 per hour or full rate of 24 hour care: $1,432.41
How Much Does In-Hospital Palliative Care Cost?
Much like in-home palliative care, costs vary for in-hospital care. Factors depend on factors such as personal insurance coverage and hospital location. However, hospice care may be a little easier to average the out of pocket costs for an individual without insurance:4
- Level 3 Short Term General Inpatient Care: $1,045.66 per day
- Level 4 Inpatient Respite Care: $461.09 per day (Respite care means a short-term break for caregivers where the patient stays in an approved nursing facility, hospital or hospice facility for up to five days).
The best way to predict costs for both in-home and in-hospital palliative care is to contact personal insurance providers regarding policies and speak to a palliative care coordinator or specialist regarding care planning.
Does Medicare Cover Palliative Care?
Medicare does cover aspects of palliative care; however, this may depend on individual medicare coverage and vary depending on type of plan enrolled in, location and coinsurance.
Medicare is federally funded health insurance. It has four parts:
- Part A (hospital insurance) covers hospital stays, short-term nursing facility stays, hospice care and limited at-home care.
- Part B (medical insurance) typically covers palliative care and treatment such as counseling and emotional support, diagnostics, and medical equipment.
- Part C (Medical Advantage) provides supplemental covers for things like medication and long-term care as well as offers Special Needs Plans which helps with options for palliative care.
- Part D (Prescription Drugs) provides coverage for palliative care prescription drugs
See a detailed cost analysis of palliative care under Medicare (Does Medicare Cover Palliative Care article from Senior Care Advisor)
Related: Palliative Care for Dementia
Does Insurance Cover Palliative Care?
Palliative care may be covered by different private and public insurance plans as well as Medicare and Medicaid. While it is always a good idea to reach out to an insurance provider directly, a palliative team member may also help find palliative services covered by an individual plan as many private plans cover palliative care benefits under hospice, long-term or chronic care.5
FAQs
Is palliative care free of charge?
Palliative care is rarely free of charge and costs depend on many personal factors such as personal insurance coverage.
Is palliative care more expensive than hospice?
More often private and public insurance policies cover hospice and end of life care. Speak to a policy representative in order to understand coverage and costs of palliative care and hospice care.
Related: Palliative Care vs Hospice
Is palliative care cost effective?
Studies6 have shown palliative care to be cost effective for both the patient and hospitals with higher savings for patients with four or more illnesses.
Resources
- https://pubmed.ncbi.nlm.nih.gov/32440909/
- https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/07/10/why-some-patients-arent-getting-palliative-care
- https://www.chcf.org/wp-content/uploads/2019/06/SB100423FactorsThatImpactCostDeliveringPalliativeCare.pdf
- https://hospicevalley.com/how-much-does-hospice-care-cost-out-of-pocket/
- https://getpalliativecare.org/palliative-care-is-covered-under-both-public-and-private-insurance-plans/
- https://www.usnews.com/news/health-care-news/articles/2018-04-30/study-palliative-care-reduces-hospital-stay-cost-of-sickest-patients
- What are the Five Stages of Palliative Care
