Hospice vs palliative care: the difference and who pays

Palliative care is treatment of the discomfort, symptoms and stress of a serious illness, and you can get it at any stage of an illness. Hospice is end-of-life care for a person expected to live 6 months or less, and under Medicare it means accepting comfort care instead of care to cure the illness.

The difference side by side

	Palliative care	Hospice care
What it is	Treatment of the discomfort, symptoms and stress of serious illness	End-of-life care, with medical, psychological and spiritual support
When it can start	At any stage of an illness	When a hospice doctor certifies a life expectancy of 6 months or less (Medicare)
Aim	Ease symptoms such as pain, breathlessness, fatigue, nausea and sleep problems	Comfort, peace and dignity
Where	The sources we read do not name a setting	Home, a hospice center, a hospital or a skilled nursing facility

Sources: MedlinePlus (palliative care and hospice care pages) and Medicare.gov. MedlinePlus also says hospice care always includes palliative care. So hospice is one form of palliative care, and palliative care can be used well before hospice.

What palliative care covers

MedlinePlus describes palliative care as treatment of the discomfort, symptoms and stress of serious illness. It aims to ease symptoms such as pain, breathlessness, fatigue, nausea and sleep problems, and it can also help you deal with the side effects of the medical treatments you are receiving.

Because you may receive it at any stage of an illness, you do not have to be dying to ask about it. The sources we read do not say how palliative care outside hospice is paid for, and that depends on your own coverage. Ask your doctor and your insurer or plan.

What hospice covers under Medicare

Medicare.gov says Part A (Hospital Insurance) covers hospice care if you are eligible. Hospice requires Medicare Part A, certification by the hospice doctor (and your regular doctor, if you have one) that you are terminally ill with a life expectancy of 6 months or less, acceptance of comfort care instead of care to cure the illness, and a signed statement choosing hospice.

Other points from Medicare.gov:

• Benefits come in two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
• Hospice does not cover treatment intended to cure your terminal illness or related conditions, or prescription drugs meant to cure rather than control symptoms or relieve pain.
• Original Medicare still pays for health problems unrelated to the terminal illness, and you may owe deductibles and coinsurance for those.
• You pay nothing for hospice care from a Medicare-approved hospice provider. Outpatient drugs for pain and symptom management can carry a small copayment, and inpatient respite care costs 5% of the Medicare-approved amount.
• You can change hospice providers once per benefit period.

For the wider Medicare picture, see what Medicare covers.

MedlinePlus says hospice care is provided by a team of health care professionals and volunteers who give medical, psychological and spiritual support, and that hospice programs also support the patient's family. Ask each hospice who is on its team and how often they visit.

Where hospice care happens

MedlinePlus says hospice care can be given at home, at a hospice center, in a hospital or in a skilled nursing facility. Medicare.gov says you can usually get Medicare-approved hospice care in your home or the facility where you live, which can be an assisted living facility or nursing home.

What catches people out: hospice does not pay for room and board. Medicare.gov says you may have to pay for room and board if you live in a facility such as a nursing home and choose hospice. Hospice also does not cover hospital, emergency room or ambulance care unless the hospice team arranges it or it is unrelated to the terminal illness. If a family member lives in a facility, ask the facility and the hospice who pays what before anyone signs.

How to choose between them

Two questions can help.

1. Is the goal still to cure the illness? If yes, ask the doctor about palliative care alongside current treatment. If the person and the care team have decided that comfort is the goal, and a doctor certifies a life expectancy of 6 months or less, hospice is the Medicare benefit built for that.
2. What does the person want? Medicare hospice requires a signed statement choosing hospice.

A doctor can explain which fits a particular illness. Carevo does not give medical advice and does not assess eligibility.

How to compare hospices

CMS says Care Compare on Medicare.gov is the official place where hospice quality measures are publicly reported. The measures draw on assessments hospices submit, Medicare claims and the CAHPS Hospice Survey. CMS describes the program as pay-for-reporting. A hospice that does not submit complete data on time faces a payment penalty, and performance is not a factor in the annual payment update, so a published result does not tell you the hospice met a performance standard for payment.

Treat the numbers as one input. Ask each hospice:

• Which services it provides at home and which it arranges elsewhere.
• Who to call after hours, and how fast someone answers.
• How it works with a nursing home or assisted living facility if that is where the person lives.
• What it expects the family to pay, in writing.

You can look at hospices near you on our hospice directory, and see how states compare on Medicare care ratings by state. Our methodology explains where those ratings come from. If you are comparing settings and costs for the person who needs care, the care cost comparison lets you put your own quotes side by side.