Who pays for palliative care: Medicare, Medicare Advantage, Medi-Cal and the VA

Palliative care is often what a family needs long before hospice, and the first question is usually what it costs. Unlike hospice, Medicare has no separate palliative care benefit. Medicare and Medicaid don’t use the word “palliative,” but the services are covered the way other medical care is, with the usual deductibles and copays.¹ This note explains how that works with Original Medicare, Medicare Advantage, Medi-Cal and the VA, and what to ask before the first visit.

The short answer

• Palliative care is covered by Medicare, Medicaid and most private plans, with the usual cost-sharing.¹
• With Original Medicare, Part B covers visits from doctors, nurse practitioners, physician assistants and clinical social workers. After the Part B deductible, you usually pay 20% of the Medicare-approved amount.²
• A Medigap policy can help pay the copayments, coinsurance and deductibles that Original Medicare leaves.³
• Medicare Advantage plans must cover everything Original Medicare covers, but may require in-network providers, referrals or approval in advance.⁴
• With a Medicare drug plan, once out-of-pocket costs for covered drugs reach $2,100 in 2026, covered drugs cost nothing for the rest of the year.⁵
• Enrolled veterans who meet the clinical need are eligible for VA palliative care, and copays may be charged.⁶

Why there’s no palliative care line on the bill

Insurance pays for a palliative care team’s visits the way it pays for other medical visits, with normal cost-sharing, whether they happen in an office, a nursing facility or at home.¹ The difference from hospice is that there’s no single benefit that wraps everything together.

With Original Medicare

Medicare Part B covers medically necessary services from doctors, nurse practitioners, physician assistants, clinical social workers and other providers. After you meet the Part B deductible, you usually pay 20% of the Medicare-approved amount for most services.²

A Medigap policy, extra insurance bought from a private company, can help pay what’s left in Original Medicare, like copayments, coinsurance and deductibles.³ Medicare Part B also covers advance care planning, at no cost when it’s part of the yearly Wellness visit and the provider accepts assignment.⁷ Advance care planning in California explains the forms.

With Medicare Advantage

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers. They may also require you to use providers in the plan’s network, get a referral to see a specialist, or get approval from the plan before it covers certain services. Plans also have a yearly limit on what you pay for covered services.⁴

Before the first visit, call the number on the plan card and ask three things: whether the palliative care team is in network, whether home visits need approval in advance, and what you’ll owe for each visit.

Medicines

Outside hospice, the medicines a palliative care team prescribes are paid the usual way, through the person’s drug coverage, with the plan’s copays. With a Medicare drug plan, there’s a ceiling: once what you pay out of pocket for covered Part D drugs reaches $2,100 in 2026, you pay nothing for covered drugs for the rest of the calendar year.⁵

Two programs can help along the way. The Medicare Prescription Payment Plan spreads out-of-pocket drug costs into monthly payments, though it doesn’t lower them. Extra Help pays drug costs for people with limited income and resources, and anyone with Medi-Cal qualifies automatically.⁵

If leaving home is hard

A person with a serious illness may also qualify for Medicare home health, which is a separate benefit. When the person is homebound and needs part-time skilled nursing or therapy, and a provider has seen them in person and ordered the care, you pay nothing for covered home health services.⁸ If both teams are involved, ask how they’ll work together. Who qualifies for home health care? explains the rules.

With Medi-Cal

Medi-Cal has its own palliative care benefit, with its own rules for who qualifies and what it covers. Medi-Cal palliative care explains them. For people with both Medicare and Medi-Cal, ask the team which coverage pays first.

For veterans

VA palliative care focuses on relieving suffering and controlling symptoms, and it can be combined with treatment aimed at curing or controlling an illness. All enrolled veterans are eligible if they meet the clinical need, and copays may be charged. To start, talk with the VA primary care provider or a VA social worker.⁶

When hospice is the better fit

If the illness reaches the point where hospice fits, the money works differently. With Medicare, hospice care from a Medicare-approved hospice costs the family nothing, apart from a copayment of up to $5 per prescription for pain and symptom medicines.⁹ Palliative care vs. hospice explains how to tell which one fits, and Who pays for hospice? covers the rest.

Questions to ask before the first visit

• Is your palliative care team in my plan’s network?
• Does my plan need a referral or approval in advance?
• What will I owe for each visit, at home and in the office?
• Will you bill my Medigap policy or Medi-Cal after Medicare?
• If the person is homebound, could home health visit too?
• Who on your team can help me sort out coverage questions?