Does Medicare Cover End-of-Life Counseling?

If you or a loved one is facing a terminal diagnosis, you might be wondering whether Medicare covers end of life counseling. The answer is yes, it does. Medicare covers therapy and counseling under Part B, which includes out-patient therapy for mental health.

While you may not find the term “end of life counseling” in reference to Medicare coverage, Medicare will cover counseling that includes helping you manage the emotional, psychological, and spiritual challenges that come at the end of life.

End of life is an intensely emotional time, and it can be hard to navigate things like insurance coverage. This guide will walk you through everything you need to know about Medicare reimbursement for end of life counseling, and how to get the care and support you need.

Key takeaways

• Medicare covers end of life counseling under the Part B benefit, which includes therapy and counseling.
• End of life counseling is a description of what’s covered during a Medicare therapy session, but isn’t a Medicare billing code. Your provider will bill for therapy services, and then tailor your sessions to include end of life counseling.
• Caregivers of terminally ill patients can receive grief and loss counseling, either through Medicare, or through another insurance provider.

Psychotherapy for end-of-life issues

End of life counseling, sometimes referred to as end of life therapy or death therapy, is a type of talk therapy for people who are facing a terminal illness or are in hospice care. There are many different forms that end of life counseling can take, and sessions are typically personalized to your needs.

It’s completely normal to experience anxiety and depression at the end of life. In fact, 20% of people with terminal illness experience depression. Death anxiety, also known as thanatophobia, is also common and treatable with therapy.

Even if you aren’t experiencing these specific challenges, end of life is a time where you may want to understand the life you lived better, consider your legacy, and think about what you want for your loved ones going forward.

End of life counseling may include:

• Reminiscing and reviewing life events
• Considering one’s legacy
• Working through the emotions that come at the end of life
• Making meaning out of your life
• Consideration of what your hopes and dreams are for your loved ones after your death

Various therapeutic methods can be helpful for people at the end of their lives, including:

• Dignity therapy
• Cognitive-behavioral therapy (CBT)
• Acceptance and commitment therapy (ACT)
• Meaning-centered psychotherapy

All of these approaches address the emotional, spiritual, and psychological issues that are often experienced at the end of life. 

How end of life counseling gets billed to Medicare

 “End of life counseling” is a descriptive term to describe what happens in therapy or counseling sessions when someone is at the end of their life. It’s not a specific Medicare billing code, which means your therapist can’t bill Medicare for “end of life therapy” or “end of life counseling.”

Instead, your provider will bill Medicare for standard psychotherapy. When therapists bill Medicare, they need to show that therapy is “medically necessary” so they will bill for a condition that is related to what you are experiencing, such as anxiety, depression, or adjustment disorder. These types of mental health conditions are used for billing purposes so your counseling will be covered.

It’s important to emphasize that while people at the end of their life frequently experience depression and anxiety related to what they’re experiencing, terminal illness doesn’t cause mental illness and you are not being labeled as “mentally ill” just because your provider uses these diagnostic codes for billing. 

What you pay out of pocket

As with other forms of psychotherapy, once you’ve met your Medicare Part B deductible, you’ll to pay 20% of the Medicare-approved fee. Sailor Health works with Medicare to cover up to 100% of the cost, and most of our patients have a $0 copay.

Counseling vs advance care planning

Sometimes, if you mention that you are looking for end of life support, your doctor will think that you mean “end of life planning.” End of life planning includes things like living wills, healthcare proxies, power of attorney documents, do not resuscitate (DNR) orders and other financial and medical documents.

End of life planning is crucial, and something we should all do, but it’s not the same as end of life counseling.

What people are looking for when they ask their medical provider about end of life counseling is emotional support, coping strategies, and a safe way to share and talk about what they are feeling.

If you’re having trouble putting into words what you’re looking for, consider saying something like this to your medical provider: “I need mental health therapy to help me cope with a terminal illness.”

If you’re a family looking for end of life counseling for a loved one, you might say: “I’m looking for a therapist or counselor to support my loved one as they face a terminal illness.”

Support for caregivers

Caregivers of terminally ill patients need support too. If you’re the adult child or spouse of someone who is dying, you’re likely experiencing heavy and challenging emotions. This is normal and understandable, but that doesn’t mean you don’t need support to navigate these feelings.

Additionally, sometimes caregivers experience serious mental health challenges when losing a loved one. For example, adjustment disorder is a common experience when facing grief and loss. It involves feelings of anxiety, sadness, hopelessness, and stress that are stronger and more long-lasting than typical reactions to grief and loss.

If you’re a Medicare beneficiary yourself, your therapist can bill for adjustment disorder so your grief therapy can be covered. Other common reactions to grief and loss that have formal diagnoses and can be medically documented for Medicare and other health insurance companies include:

• Anxiety
• Depression
• PTSD
• Prolonged Grief Disorder (PGD) 

How Sailor Health can help

When you’re terminally ill, it can be challenging if not impossible to travel to a therapist’s office. That’s why telehealth can be such a helpful and comforting way to receive end of life counseling. Therapy can happen in your own home, on the phone or on a video call. Your loved ones can help you set this up and can even be present for the session, if you want. Therapy can happen at your bedside or in your favorite chair—wherever you feel most comfortable.

Sailor Health providers specialize in geriatric mental health. That means that they’re experienced in discussing mortality, legacy, death anxiety, and the intense emotions that can surface at the end of life. These are topics that generalist therapists or younger therapists might shy away from or be less competent at supporting.

We make it easy to get started: schedule a complimentary call with our director of care. We’ll check your insurance coverage and help match you with a therapist and create a personalized care plan. Once you connect with Sailor Health, you may begin therapy in as little as 24 hours after.

End of Life Therapy FAQ

How many end-of-life counseling sessions will Medicare pay for?

There are no limits to how many counseling sessions Medicare will pay for, including end of life counseling sessions. However, your provider may need to provide documentation that the sessions continue to be medically necessary.

Does Medicare cover grief counseling for family members after a death?

Yes, Medicare’s hospice benefits include bereavement counseling for family members after a patient’s death. 

Do I need a referral from my doctor to see a therapist?

No, with Medicare Part B, you don’t need a referral from a doctor to see a therapist. Your therapist just needs to be in-network with Medicare and accept your Medicare assignment.

References

1. Medicare.gov (2025). Medicare & Your Mental Health Benefits. https://www.medicare.gov/publications/10184-medicare-and-your-mental-health-benefits.pdf 
2. Keall, R. M., Clayton, J. M., & Butow, P. N. (2015). Therapeutic life review in palliative care: a systematic review of quantitative evaluations. Journal of pain and symptom management, 49(4), 747–761. https://doi.org/10.1016/j.jpainsymman.2014.08.015 
3. Kredentser, M. S., & Chochinov, H. M. (2020). Psychotherapeutic Considerations for Patients With Terminal Illness. American journal of psychotherapy, 73(4), 137–143. https://doi.org/10.1176/appi.psychotherapy.20190048 
4. Sinoff G. (2017). Thanatophobia (Death Anxiety) in the Elderly: The Problem of the Child's Inability to Assess Their Own Parent's Death Anxiety State. Frontiers in medicine, 4, 11. https://doi.org/10.3389/fmed.2017.00011 
5. Social Security Administration (2026). Medicare. https://www.ssa.gov/pubs/EN-05-10043.pdf
6. Medicare.gov (n.d.). Mental health care (outpatient).
7. https://www.medicare.gov/coverage/mental-health-care-outpatient
8. National Institute on Aging (2023). Getting Your Affairs in Order
9. Checklist: Documents to Prepare for the Future. https://www.nia.nih.gov/health/advance-care-planning/getting-your-affairs-order-checklist-documents-prepare-future
10. MedlinePlus (2024). Adjustment disorder. https://medlineplus.gov/ency/article/000932.htm
11. Centers for Medicare and Medicaid Services (2026). Billing and Coding: Psychiatry and Psychology Services. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56937‍
12. Centers for Medicare and Medicaid Services (2024). Hospice. https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice