Does Anthem cover hospice or palliative care?
Short answer
Insurance question
Generally yes. For Anthem Medicare Advantage members, hospice care is paid through Original Medicare Part A — not the MA plan — so the federal hospice benefit applies directly. For Anthem commercial plans, hospice and palliative care coverage depends on your specific plan's benefits, but most plans cover medically necessary hospice and palliative services.
This is an independent research summary, not official coverage information. Your plan is the final word.
Key facts
Medicare hospice benefit: two-physician certification, life expectancy ≤6 months, comfort-care election required.
Even Anthem Medicare Advantage members receive hospice benefits through Original Medicare Part A, not the MA plan.
Under federal hospice benefit, most covered services cost $0; small copays apply only to outpatient symptom-relief drugs and inpatient respite care.
Here's the nuance
A one-liner rarely tells the whole story. This is the honest detail behind the short answer above.
Hospice care is designed for patients with a terminal illness and a life expectancy of six months or less (as certified by two physicians), who choose to focus on comfort rather than curative treatment. Under Original Medicare Part A — which remains the payer for hospice even when a member has a Medicare Advantage plan like Anthem — covered hospice services include nursing care, medical social services, physician services, counseling, short-term inpatient care for pain management, and medications related to the terminal diagnosis. Under this federal benefit, you generally pay $0 for covered hospice services, with a small copay for certain outpatient symptom-relief drugs and approximately 5% for inpatient respite care. Critically, even if you have an Anthem Medicare Advantage plan, you receive hospice benefits through Original Medicare Part A — not through your Anthem plan directly.
Palliative care outside of hospice (i.e., comfort-focused care given alongside curative treatment) is handled differently. Under federal rules, Medicare Advantage plans must cover everything Original Medicare Part A and Part B covers, which includes palliative care services that fall within those benefits (e.g., pain management visits, specialist consultations). Anthem commercial plans generally cover palliative care services as standard medical benefits, subject to deductibles, copays, and any prior authorization requirements depending on the setting and plan type.
For Anthem commercial (employer-sponsored or individual/family) plan members, hospice coverage is often included in the benefit design, but the specifics — what services are covered, whether a prior authorization is required, cost-sharing amounts, and facility network requirements — vary by plan. Medical necessity documentation from the treating physician is typically required for hospice admission.
If you or a loved one is exploring hospice or palliative care, call the member services number on the back of the Anthem ID card. Ask specifically about what's covered under your plan, whether prior authorization is needed, and which hospice providers are in-network. A social worker at your hospital or doctor's office can also help navigate the process.
The key points
The handful of things that decide the answer — skim these if you only read one section.
Anthem MA members get hospice through Original Medicare Part A
Even if you have an Anthem Medicare Advantage plan, hospice care is paid by Original Medicare Part A — not the MA plan. The federal hospice benefit (two-physician certification, comfort-focused care, $0 for most covered services) applies directly.
Medicare hospice generally costs $0 for covered services
Under the Medicare hospice benefit, most covered services cost nothing. There may be a small copay (up to $5) for symptom-relief drugs and roughly 5% coinsurance for inpatient respite stays. Premiums and deductibles do not apply to covered hospice services.
Palliative care outside hospice follows standard medical benefits
For Anthem commercial plans, palliative care services (pain management, specialist visits, counseling alongside curative treatment) are generally covered as medical services subject to normal cost-sharing — deductibles, copays, and coinsurance per your plan.
Commercial plan hospice coverage varies — prior auth often required
Anthem commercial plans may require prior authorization for hospice admission and documentation of medical necessity. Coverage specifics, including which facilities are in-network, differ across plan designs. Always verify before starting care.
Confirm hospice providers are in-network
Hospice agencies vary in Anthem network participation. Using an out-of-network hospice provider under a commercial plan can result in significantly higher cost-sharing. Call Anthem member services or use the online provider directory to find in-network hospice agencies.
Confirm before you rely on this
Coverage varies by plan — this is not official
Coverage rules, benefit tiers, and medical-necessity criteria change often and differ by plan type, state, employer, and your specific policy. This page is a general, independent research summary — it is not official information from any insurer, not a benefits determination, and not financial or insurance advice.
Verify your exact coverage by calling the member number on your insurance card or checking your plan documents before you rely on any answer here.
❓Frequently Asked Questions
No — this is a common point of confusion. Even if you're enrolled in an Anthem Medicare Advantage plan, hospice care is paid through Original Medicare Part A, not through your Anthem plan. This means federal hospice benefit rules apply: two-physician certification of terminal illness with a life expectancy of six months or less, and you choose comfort-focused care over curative treatment. Contact your Anthem plan to confirm how to begin the hospice enrollment process.
Palliative care — comfort-focused care given alongside curative treatment — is generally covered by Anthem plans as part of standard medical benefits, even for non-terminal conditions. Services like pain management consults, specialist visits, and psychosocial support are typically billed as regular medical visits subject to your plan's deductible and copays. Some Anthem plans may require referrals or prior authorization for certain palliative services. Verify with your plan's member services.
Yes, in most cases. The Medicare hospice benefit (applicable to Anthem MA members through Original Medicare Part A) covers home hospice nursing visits, aide services, medical social work, counseling, and medications related to the terminal diagnosis — all in the home setting. For Anthem commercial plan members, home hospice coverage depends on the specific plan benefits; prior authorization is often required. Check your Summary of Benefits and Coverage for home hospice benefit details.
For Anthem Medicare Advantage members, hospice care is handled through Original Medicare Part A and does not require MA plan prior authorization — but the hospice agency itself must be Medicare-certified. For Anthem commercial plan members, prior authorization is commonly required before starting hospice care. Medical necessity documentation from the treating physician is also typically needed. Contact Anthem member services before initiating hospice to understand your plan's specific requirements.
Hospice is a specific benefit for terminal illness (life expectancy six months or less) where the patient chooses comfort over curative care — it is a defined Medicare benefit paid through Part A for Medicare and MA members. Palliative care is broader and can run alongside curative treatment at any illness stage — it is generally billed as standard medical care subject to normal cost-sharing. The distinction matters for what authorization steps apply and which benefit bucket pays. Ask your Anthem plan which category applies to your situation.
Reviewed by
Curex Editorial TeamReviewed for accuracy
Last reviewed July 2026
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Read moreYour plan has the final say
The surest way to know what's covered is to ask the source. Call the member number on your insurance card or sign in to your plan portal, and have the service or medication name ready — a quick call beats guessing.
This page is independent research, not a benefits determination — your insurer's answer is the one that counts.
This content is for general informational purposes only. It is not official coverage information, a benefits determination, or financial or insurance advice. Coverage rules, benefit tiers, and medical-necessity criteria change often and vary by plan, state, and effective date — always verify your specific benefits directly with your insurer before making any decision.