Palliative Care vs. Hospice: What’s the Difference?

Although hospice care and palliative care are both used to ease symptoms and improve the quality of life of people with serious medical conditions, their aims and intent are different.

Hospice care is intended for people with a terminal illness who decide to forego curative treatment and focus instead on comfort care. Palliative care is intended for anyone with a serious illness, whether or not they are at the end of life. Hospice and palliative care also differ is now how insurance benefits are paid and approved.

This article helps you understand what palliative and hospice care are, including their goals, treatments, and limitations. It also explains what is covered by insurance and how to make an informed choice for yourself or a loved one.

Couple sitting on couch talking to a healthcare provider — SDI Productions / Getty Images

What Is Palliative Care?

Palliative care is a medical specialty aimed at easing the physical, emotional, psychological, and social burden you and your family experience as a result of a serious medical condition.

Palliative care can be arranged as soon as you are diagnosed with a serious illness. A person can continue to receive palliative care as long as they have the condition and a means to pay for it.

The four primary goals of palliative care include:

Maximizing the quality of life of people with a serious medical condition
Providing relief from pain and other symptoms of the condition
Providing psychological, emotional, social, and spiritual/religious support
Offering support to help caregivers and family

The treatment plan can vary and evolve based on the status of your condition and your individual needs and preferences.

Is Palliative Care a Step Before Hospice?

Not always. Palliative care can sometimes advance to hospice care if your condition worsens and there is no hope of improvement. With that said, many people in palliative care do improve and can return home with no further need for treatment.

Conditions Benefiting From Palliative Care

Many medical conditions qualify for palliative care. They are generally serious conditions that have become difficult for you and your caretakers to manage both functionally and emotionally. Insurance coverage can vary, with some providers covering certain conditions and others not.

Some of the conditions that generally qualify for palliative care include:

How Serious Does an Illness Need to Be?

Some conditions that qualify for palliative care may lead to early death, although this is not a prerequisite for care. Palliative care can be delivered irrespective of life expectancy.

On the flip side, having an end-stage disease doesn't automatically mean you need hospice care. If your intention is to pursue life-extending treatment, palliative care can be pursued.

What Is Hospice?

Hospice care is a form of palliative care. Like all palliative care, the goal is to manage symptoms and improve the quality of life of someone with a serious illness. However, hospice is intended for people with a terminal (life-ending) illness who have decided to stop treatments used to extend life.

Hospice care instead focuses on comfort care, pain management, symptom relief, and meeting the emotional, spiritual, and psychological needs of people and their families as the end of life approaches.

Hospice focuses more on quality than quantity of life. Generally, hospice is pursued when a person has less than six months to live, but that's not a hard-and-fast rule. Some people may live longer, but that generally means months and not years.

Transitioning to Hospice

A facet of palliative care is preparing an individual and their caregivers for all contingencies, including a possible transition from palliative care to hospice care.

This is described in the "Five Stages of Palliative Care" which directs the appropriate course of action based on the status of a person's medical condition:

Stage 1: The palliative care strategy is designed and implemented when your condition is stable. This may include advance care planning to state your medical wishes.
Stage 2: The strategy has to adapt if the condition worsens. This includes ensuring the emotional readiness of the individual and their loved ones if a downturn occurs.
Stage 3: This is the transition to end-of-life care when the condition deteriorates. It doesn't mean a person is ready for hospice, but it does mean that the long-term outlook may not improve.
Stage 4: The condition is terminal and the transition to hospice care is most common. The focus would then shift from life extension to solely comfort care.
Stage 5: Bereavement support and assistance are provided to family, loved ones, and caregivers as a loved one nears death.

Palliative Care vs. Hospice: Differences

There is a lot of overlap between palliative and hospice care, from how treatment is dispensed to insurance eligibility and coverage. Here is a snapshot of the key differences:

	Palliative Care	Hospice Care
Intended for	Anyone with a serious illness	Anyone with a serious illness who has a short time to live, typically less than six months
Treatment	Can receive curative or life-extending treatment	Does not receive curative or life-extending treatment
Diagnosis	The covered condition must be diagnosed by a physician	A physician must certify that you have less than six months to live
Duration of Care	Can receive care as long as needed or as long as the care is covered by insurance	As long as your condition is reported as terminal, though benefits may cease or require recertification if you live more than six months
Private Insurance	May be covered depending on your plan	May be covered depending on your plan
Public Insurance	May be covered depending on your plan	Partly covered by Medicare, TRICARE, VA, and possibly Medicaid in your state
Location	In a home, assisted living facility, nursing home, hospital, or palliative care facility	In a home, assisted living facility, nursing home, hospital, or hospice facility

Who Is Eligible?

Eligibility for palliative care depends on your insurance coverage. Most serious or life-threatening conditions will qualify for coverage.

Hospice care has more stringent rules:

A physician (only an MD or DO) must certify that you have a terminal illness and are not expected to live more than six months.
You must also agree not to seek curative treatment for your condition while you are in hospice. Instead, your care will focus on managing your symptoms as you approach the end of life.

The benefit of hospice is that you can opt to receive care at home, in a nursing home, in the hospital, or at a licensed hospice facility. However, keep in mind that hospice insurance benefits generally do include payment for room and board if you are in a facility.

Can I Leave Hospice?

If your situation changes, either because you get better or decide that you would like to pursue treatment, you can leave hospice at any time. You can opt to sign up again if you so choose.

Who Provides Care?

When you enroll in a palliative care or hospice program, you will be assigned a team of specialists covering a wide range of care and services, such as:

Physicians, nurses, and other primary healthcare providers
Therapists (physical, occupational, and speech)
Nutritionists
Pharmacists
Social workers
Spiritual advisors (rabbis, pastors, etc.)

These providers can work in collaboration with your primary healthcare provider to ensure you get the comprehensive care you need and desire.

When you are in hospice, it is important to note that all care you receive must be approved by your hospice physician. With prior authorization, the treatment may not be covered by your insurance.

Insurance Coverage

Coverage for palliative care varies based on your insurance coverage, and you should check with your plan to see what benefits will be covered. Medicare covers palliative care under the Part B benefit. You can expect to pay a 20% coinsurance for each service you receive.

Hospice benefits may or may not be offered by private insurance plans.

However, hospice care is covered by Medicare and TRICARE. It is also covered by the Veterans Administration (VA), though there can be some variation in the coverage, and by Medicaid in some states.

Most people receive hospice care through Medicare by the Part A benefit. There is no deductible to pay, and the bulk of care you receive under hospice will be free or at a low cost.

Hospice pays for all care related to your terminal condition, including hospitalizations. But if you need treatment for an unrelated condition, your Original Medicare benefits will be used, requiring you to pay the usual Part A or Part B costs.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan may help you pay for non-hospice-related services. Out-of-pocket expenses while in Medicare-authorized hospice care include a $5 co-pay for hospice-approved medications and 5% for respite care.

As a reminder, insurance generally does not cover room and board if you move into a facility like a nursing home. That may need to be paid out of pocket.

What Is Respite Care?

Respite care is included as a hospice benefit to provide caregivers with a period of relief from their duties. Medicare will cover respite care for up to five days in a hospital, hospice facility, or skilled nursing facility. Respite care must be approved by the hospice team and can be requested on an as-needed basis.

How Long Can a Person Receive Care?

Palliative care can continue as long as you have your condition, although some insurers may have limitations on coverage.

Hospice, however, can only continue as long as your condition is reported to be terminal. If your condition gets better at the end of your hospice benefit period and you are expected to live longer than six months, you may no longer be eligible for hospice

In such cases, recertification of your terminal illness by a physician can extend the hospice benefit period. As long as your condition remains terminal, there is no limit to the number of recertifications you can submit.

Physicians make the best estimates of life expectancy based on statistics and factors such as your current health, current symptoms, response to treatment, and available treatment options. You could live much longer than that.

Deciding to Get Palliative or Hospice Care

Deciding to pursue palliative care is easier than choosing to enter hospice care because you continue receiving treatment for your condition. Your condition and overall health are likely to improve from the added services.

The decision to enroll in hospice care can be more difficult to navigate, both personally and emotionally. This is because a terminal diagnosis means that your life expectancy is short even if there are treatments available to you. Those realities alone can take time to come to terms with.

In the end, you must decide whether you want to extend your life for as long as possible or if it is more important to you to approach the end of life with as much comfort and quality of life as possible. There is no right or wrong answer. Speaking with family, loved ones, or spiritual leaders may help you make these complicated decisions.

If you are making this decision for a loved one, be respectful of their wishes. You can turn to any advance care planning documents they may have prepared (such as a living will or advance directive) to ensure that their wishes are respected.

Summary

Palliative care and hospice care are not the same thing. Palliative care is for anyone who has a serious medical condition, while hospice care is for those who are at the end of life. In both cases, a care team will provide services to improve symptoms and quality of life. The primary difference is that you can continue curative treatment with palliative care but not hospice care.

Treatment for palliative care can continue for as long as needed (or until insurance benefits run out), while hospice care benefits last for six months (after which recertification of your terminal diagnosis is needed).

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute on Aging. What are palliative care and hospice care?
International Association of Hospice & Palliative Care. Guidelines and suggestions for those starting a hospice/palliative care service.
Centers for Medicare and Medicaid Services. Hospice.
Centers for Medicare and Medicaid Services. Medicare hospice benefits.
Centers for Medicare and Medicaid Services. Medicare benefit policy manual.
Tricare. Hospice care.
Department of Veterans Affairs. Hospice care.
Centers for Medicare and Medicaid Services. Hospice benefits.
National Hospice and Palliative Care Organization. NHPCO facts and figures 2022.

By Tanya Feke, MD
Dr. Feke is a board-certified family physician, patient advocate and best-selling author of "Medicare Essentials: A Physician Insider Explains the Fine Print."

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