The main difference between palliative care and hospice is timing and treatment. Palliative care is comfort and support for anyone with a serious illness, at any stage, and you can keep getting treatment meant to cure or slow the disease at the same time. Hospice care is a specific kind of palliative care for the last months of life. It is for people whose doctors expect them to live six months or less if the illness runs its usual course, and who have decided to stop curative treatment and focus on comfort.
So every hospice patient gets palliative care, but many people receiving palliative care are not on hospice. That is the core difference between hospice and palliative care. The two also get paid for differently. Under Medicare, these visits are usually billed like other doctor visits under Part B, while hospice has its own benefit under Part A that covers almost everything related to the terminal illness.
Palliative care and hospice care at a glance
| Palliative care | Hospice care | |
|---|---|---|
| Main goal | Relief from symptoms, stress, and pain, plus a better quality of life | Comfort and dignity at the end of life |
| When it can start | At any stage of a serious illness, even at diagnosis | When a doctor expects six months or less to live |
| Curative treatment | Yes, you can keep it | No, for the terminal illness (with some exceptions for children) |
| Who provides it | Palliative care specialists working alongside your other doctors | A Medicare-approved hospice team |
| Where | Hospital, clinic, nursing home, or at home | Mostly at home, also in nursing homes and hospice facilities |
| How Medicare pays | Part B for doctor and nurse practitioner visits, with the usual deductible and 20% coinsurance | Part A hospice benefit, with no deductible and small copays |
| How long | As long as you need it | Two 90-day periods, then unlimited 60-day periods if you still qualify |
What palliative care is and who can receive it
Palliative care, also called palliative medicine, is specialized medical care for people living with a serious illness, such as cancer, heart failure, COPD, kidney disease, dementia, Parkinson’s disease, or ALS. According to the National Institute on Aging, it can start as early as the day of diagnosis and can go on alongside other medical treatment for the disease.
This type of care focuses on improving quality of life for the patient and the family. The team looks at the whole person, not just the disease. They treat pain, shortness of breath, nausea, fatigue, anxiety, and trouble sleeping. They help you understand your treatment options and talk through what matters most to you. They also support the family caregiver, who often carries a heavy load. Social workers on the team can help with forms, insurance questions, and finding help at home.
It does not replace your regular doctors. The team works with your oncologist, cardiologist, or primary care provider, and adds an extra layer of support. You may be eligible for palliative care at any age and at any stage of illness, and you do not need a prognosis to qualify.
What hospice care is
Hospice care is a type of palliative care for the end of life, often called end-of-life care. It is for people with a terminal illness who no longer want treatment meant to cure the disease, or whose treatment has stopped working. Hospice care focuses on comfort, so the person can live to the end of their life as well as possible.
Hospice brings a whole team to you. That usually includes hospice physicians, nurses, home health aides, a social worker, a chaplain or spiritual counselor, trained volunteers, and a bereavement counselor for the family. Most hospice care happens at home, and a family member or other caregiver provides most of the day-to-day care between visits. If you want to picture it, our guide to what hospice at home looks like walks through a typical week.
The hospice program also provides spiritual care and short respite care stays, so the family caregiver can rest for a few days. Hospice care also supports the family after the death. Medicare-certified hospices offer grief and bereavement support to the family for up to a year.
The key differences between hospice and palliative care
Goals of care
Both care teams share the same heart: comfort, dignity, and quality of life. The difference is what sits next to that goal. With palliative care, you can still aim to cure the illness or slow it down. With hospice, the goal of care is comfort alone, because the illness is no longer expected to improve.
Timing and prognosis
You can receive palliative care with no time limit and no prognosis rule. You can start it early and use it for years. Hospice requires a prognosis. Under Medicare, the hospice doctor and the patient’s regular doctor, if they have one, must certify that the person is terminally ill with a life expectancy of six months or less if the illness runs its normal course.
The six-month rule for being eligible for hospice care is a medical estimate, not a deadline. Hospice patients who live longer than six months can stay on hospice as long as a doctor recertifies that they still qualify.
Curative treatment
This is the difference families feel most. With palliative care, you can keep chemotherapy, radiation, dialysis, surgery, or any other treatment your doctors recommend. When you choose the Medicare hospice benefit, you agree to comfort care instead of treatment meant to cure the terminal illness. Medicare still pays for care of other health problems that are not related to the terminal illness.
Children are an exception. Under the Affordable Care Act, children under 21 who have Medicaid or CHIP and qualify for hospice can receive hospice care and curative treatment at the same time. This is called concurrent care, and states carry it out in different ways.
Who provides the care
Palliative care services may include visits from a palliative care doctor or nurse practitioner, nurses, and a social worker, sometimes with a chaplain. Hospice care is provided by a Medicare-approved hospice agency, which brings the full team described above and is on call 24 hours a day for questions and crises.
Where you get it
Palliative care can be provided in hospitals, outpatient palliative care clinics, nursing homes, and more and more often at home. Our guide to palliative care at home explains how home-based programs work. Hospice care for patients is mostly given wherever they live: a private home, an assisted living community, or a nursing home. Some hospices also offer inpatient care in their own units for short stays when symptoms cannot be managed at home.
How palliative care and hospice are paid for
Paying for palliative care
Medicare and Medicaid, plus most private insurance plans, cover palliative care, but usually not as one package. The visits are billed like other specialist visits. With Original Medicare, Part B covers doctor and nurse practitioner visits, and you usually pay the Part B deductible and 20% coinsurance. If you are in the hospital, Part A covers palliative care as part of your stay. Medicare Advantage plans cover the same services and may add their own programs, with their own copays and network rules.
Some things that families often need are not covered, such as round-the-clock help at home or a private caregiver for bathing and meals. Those costs usually fall to the family, long-term care insurance, or Medicaid programs for home care.
Paying for hospice care
The Medicare hospice benefit is part of Part A. It covers the hospice team, medical equipment, supplies, and drugs for pain and symptom control. You pay nothing for covered hospice services, apart from a copay of up to $5 per prescription for symptom drugs and 5% of the Medicare-approved amount for inpatient respite care.
Hospice does not cover room and board in a nursing home or assisted living, treatment meant to cure the terminal illness, or care from a hospice the team did not arrange. If your loved one is in a Medicare Advantage plan, Original Medicare pays for hospice once they choose it, and the plan keeps covering care for unrelated problems. Medicaid covers hospice in most states, and many private insurance plans and the VA cover it too. For the full picture, see who pays for hospice care at home.
What neither one usually pays for
Neither type of care usually pays for a caregiver in the home around the clock. Hospice can provide continuous care at home for short periods during a medical crisis, but not as ongoing daily help. Our guide on whether hospice covers 24-hour care explains what to expect and how families fill the gaps.
Can you get palliative care and hospice care at the same time?
Hospice already includes comfort care, so you do not need both. When someone moves to hospice, the hospice team takes over comfort care for the terminal illness. Some teams stay in touch or help with the handoff, but the hospice team becomes the main care provider.
Is palliative care a step before hospice?
Sometimes, but not always. Hospice care and palliative care are separate services. Many people get this kind of support for years and never need hospice, because their illness is managed well or they live with it for a long time. Others start early, and when the illness advances, the palliative care team helps them make the transition to hospice. Some people enroll in hospice without ever having had palliative care.
People choose to stay outside of hospice when they still want treatment for the illness, when they do not meet the six-month rule, or when they simply are not ready to stop trying. That is a valid choice. Palliative care can help with symptoms, care planning, and the care needs of the whole family.
How to move to hospice
Many people start with palliative care and later choose hospice care. The move is often easier when a team is already involved, because you have already talked about goals and wishes. Here is how it usually goes:
- The conversation starts. You, your loved one, or a doctor notices that treatment is no longer helping, or that its burdens now outweigh the benefits.
- A doctor assesses the prognosis. If the doctor believes the person has about six months or less, they can refer to hospice.
- You choose a hospice. You can ask the palliative care team for names, and you have the right to pick the hospice. Our guide to interviewing home care or hospice providers lists good questions to ask.
- A hospice nurse visits. The hospice checks that your loved one qualifies and explains what they provide.
- Your loved one signs the election statement. This form chooses the hospice benefit and starts care, often within a day or two.
Can you go back from hospice to palliative care?
Yes. Hospice is a choice, not a one-way door. Your loved one can stop hospice at any time, for example to try a new treatment or because their health has improved. They go back to their regular Medicare coverage and can keep seeing the palliative care team. If they later qualify again, they can return to hospice.
Which one is right for your family?
Palliative care focuses on living well with the illness. It may be the better fit if your loved one:
- Has a serious illness and is still getting treatment meant to cure or control it
- Has pain, breathlessness, or other symptoms that make daily life hard
- Has been in and out of the hospital and wants help planning ahead
- Is not ready, or not eligible, for hospice
Hospice care may be the better fit if your loved one:
- Has a prognosis of about six months or less
- Has decided to stop treatment meant to cure the illness
- Wants to stay at home and focus on comfort and time with family
- Needs more support at home than regular visits can give
Some families put off calling hospice because it feels like giving up. If that thought feels heavy, our guide on coming to terms with hospice care may help.
Questions to ask the doctor
- What is the goal of treatment right now, and is it still working?
- Could my loved one benefit from palliative care for the symptoms we are dealing with?
- Where can we find palliative care in this hospital, or a team that visits at home?
- Do you think my loved one would qualify for hospice now or soon?
- What would change if we chose hospice, and what would stay the same?
- What will we pay out of pocket for each of these care options under our coverage?
- Who do we call at night or on weekends if symptoms get worse?
- What help will the family need to give, and where can we get more support?
