Palliative Care Vs Hospice

However, the decision to withdraw treatment when you sign up for hospice can be a bit more difficult to navigate, both personally and emotionally. In this case, your condition is expected to be terminal despite the treatment options available to you.

What’s the Difference Between Palliative Care and Hospice?

Anju Goel, MD, MPH, is a board-certified physician who specializes in public health, communicable disease, diabetes, and health policy.

Table of Contents
Table of Contents

Palliative care and hospice care are often confused with one another. Both have the goal to relieve symptoms and improve the quality of life for people with chronic medical conditions. However, what that care includes and who qualifies for it are quite different.

Palliative care is intended to be used by anyone who has a serious illness, whether or not they are at the end of life. Someone who receives palliative care can choose to pursue curative treatments for their condition; for example, undergoing chemotherapy for cancer.

Hospice care, on the other hand, is intended for people who have a terminal condition. They decide to forego further curative treatment options and instead focus on comfort care.

If your health insurer denies your claim or treatment, you have very little time to act. Appeals to Medicare must be filed within 90 days in the most lenient states, with even shorter deadlines in some states, and many insurers and healthcare providers will turn over unpaid medical bills to collection agencies after just 60 days, the AARP

Understanding the difference between palliative care and hospice is important because it affects the care you receive and also determines how insurance will pay for it. This article reviews palliative care and hospice care, conditions treated, goals, eligibility, care providers, insurance coverage, the length of benefits, and how to choose.

What Does It Mean When Someone Is in Palliative Care?

According to the Centers for Disease Control and Prevention (CDC), more than half of Americans have a chronic medical condition that could increase their risk for health complications, impair their quality of life, and in some cases, lead to an earlier death than expected.

Palliative care is a medical specialty aimed to decrease the physical, emotional, and psychosocial (involving both psychological and social factors) burden you and your family could experience as you live with and manage these conditions.

You can arrange for palliative care as soon as you are diagnosed with a serious illness. Treatment plans will evolve over the course to meet your needs, ranging from symptom management to end-of-life care as the disease progresses.

What Is Hospice?

Hospice care is an extension of palliative care. Put another way, hospice care is a type of palliative care but not all palliative care is considered hospice care.

Like all palliative care, the goal is to manage symptoms and improve quality of life. Hospice is unique because someone on hospice has a terminal condition and has decided to stop treatments meant to cure or treat that condition.

Hospice care instead focuses on comfort care, symptom management, and the psychosocial needs of you and your family as you approach the end of life.

Conditions Treated and Goals

A number of conditions could qualify you for palliative care or hospice. The longer you have these conditions, the more likely you are to develop physical impairments or stress that could impact your day-to-day life. Some of these conditions could also decrease your life expectancy.

The goal of palliative care is not to necessarily cure or treat your condition but to make it more manageable.

Please know that the following list is not all-inclusive. Some insurers may cover palliative care for some but not all of these conditions. It is important to check with your insurer to find out what benefits are available to you. Conditions may include:

• Alzheimer’s disease
• Amyotrophic lateral sclerosis (ALS)
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• COVID-19
• Dementia
• Heart failure
• Human immunodeficiency virus (HIV)
• Huntington’s disease
• Kidney disease (chronic or end-stage)
• Parkinson’s disease
• Stroke

When it comes to hospice, 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 does not pay for room and board. That may need to be factored into your decision.

Palliative Care vs. Hospice: Differences

There is a lot of overlap between traditional palliative care and hospice care. The key differences will be highlighted here.

Who’s Eligible?

Eligibility for palliative care depends on your insurance coverage, and it is important that you reach out to your plan administrator to discuss your benefit package. Many serious or life-threatening conditions will qualify for coverage.

Hospice care, however, has more stringent rules. A physician must certify that you have a terminal illness and are not expected to live more than six months. You must agree not to seek curative treatment for your condition while you are on hospice.

Instead, your care will focus on managing your symptoms as you approach the end of life. Hospice focuses more on quality than quantity of life.

Leaving Hospice

If your situation changes, i.e., you get better or decide that you would like to pursue treatment for your condition, you can leave hospice at any time. You can opt to sign up for hospice again at a later time if you are interested.

Who Provides Care?

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

• Physicians, nurses, and other healthcare providers to care for your medical needs, including symptom and pain management
• Therapists (physical, occupational, and speech) to help you manage your activities of daily living
• Counselors to address your mental state and psychological needs
• Nutritionists to advise on your dietary needs
• Pharmacists to manage and track your medications
• Social workers to advocate for you and coordinate your care
• Spiritual leaders to support your beliefs and values, if you are so inclined

These providers can work together with your healthcare providers to make sure you get the well-rounded care you need during these difficult times.

When you are on hospice, however, it is important to know that all care must be approved by your hospice team. Any care not first approved by your team may not be covered. Be sure to reach out to your team with any questions or concerns.

Insurance and Medicare

Coverage for palliative care varies based on your insurance coverage, and you should check with your plan to see what benefits will be covered. Hospice benefits may or may not be offered by private insurance plans.

Hospice care, however, is covered by Medicare, TRICARE, and the Veterans Administration if you are terminally ill, though there can be some variation in that coverage. It is also covered by Medicaid in some states. Most people receive hospice care through Medicare.

Medicare covers palliative care under the Part B benefit. You can expect to pay a 20% coinsurance for each service you receive.

Hospice care, on the other hand, is covered 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 instead, 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.

Costs you will be expected to pay while in the Medicare hospice program include a $5 co-pay for hospice-approved medications and 5% for respite care. As a reminder, hospice does not pay for room and board.

Respite Care

Hospice care is not just for the person receiving care; it is for family and loved ones, too. 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 a limit 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.

Healthcare providers make the best estimates of someone’s life expectancy based on statistics and a number of other factors (i.e., your current symptoms, your response to treatments to date, available treatment options and their side effects, etc.). You could live longer than that.

If you are still considered terminal at the end of your hospice benefit, a healthcare provider can recertify you for continued hospice care. As long as your condition remains terminal, there is no limit to the number of recertifications you can have.

Medicare Hospice Benefit Periods

Your first two hospice benefit periods are 90 days long. All subsequent benefit periods are 60 days long. A physician must document that you have a life expectancy of less than six months to qualify you for each benefit period.

Delays in Hospice Care

Many people hesitate to discuss hospice options with their healthcare provider. They may have a misconception that these programs are about giving up hope or giving up on their loved ones. The goal is actually to improve their quality of life.

One study showed that people with metastatic lung cancer who participated in a palliative care program earlier after diagnosis had a better quality of life and nutritional status and were less likely to experience depression than people receiving standard cancer care.

According to the National Hospice and Palliative Care Organization, 1.72 million people enrolled in the Medicare hospice program in 2020. About 50% of people in the Medicare hospice program are enrolled for 18 days or less. Their report found that in 2019, 10% were enrolled in hospice for two days or less and 25% were enrolled for five days or less.

Unfortunately, these delays in enrollment did not allow many of these people to reap the program’s full benefits. They could have been made more comfortable and had more resources available to them had they enrolled earlier.

How to Decide

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. Whether or not your insurance covers that care may be the bigger issue.

However, the decision to withdraw treatment when you sign up for hospice can be a bit more difficult to navigate, both personally and emotionally. In this case, your condition is expected to be terminal despite the treatment options available to you.

You must decide whether you want to try to extend your life as long as possible or if it is more important to you to decrease your symptoms at the end of life. There is no right or wrong decision.

You are encouraged to talk with family, loved ones, and/or spiritual leaders to help you think through these complicated issues.

If you are making the decision for a family member or loved one, be respectful of their wishes. You may want to turn to any advance care planning documents they have completed, like a living will, advance directives, or Five Wishes document, to review their thoughts on the issue.

Summary

Palliative care and hospice care are not one and the same. Many people, however, use the terms interchangeably. Palliative care is for anyone who has a chronic medical condition, while hospice care is for anyone who is at the end of life.

In both cases, a care team will provide services to improve your symptoms and quality of life. The primary difference is someone on palliative care can continue to seek curative treatment for their condition while someone on hospice does not.

Coverage by private insurance plans will vary, but many plans will offer both services, at least to some degree. Most people who get hospice care will do so through Medicare, but Medicaid, TRICARE, and the Veterans Administration may also provide hospice benefits.

A Word From Verywell

Being diagnosed with a serious, chronic condition can be overwhelming. If that condition becomes terminal, even more so. Know that resources available to you can improve your experience, making things more comfortable for you and your loved ones, not just physically but also emotionally and spiritually.

Unfortunately, palliative and hospice care are underutilized in the United States or often used too late in the disease course. Reach out to a healthcare provider if you want to learn more about what these programs offer.

Frequently Asked Questions

Is palliative care the step before hospice?

Palliative care includes hospice care, but not all palliative care qualifies as hospice. Palliative care is care given to someone with a serious medical condition and is available to them whether they are receiving targeted treatment for that condition or not. On the other hand, hospice care is limited to people with a terminal illness who no longer receive curative treatments for that condition.

How long can a person stay in palliative care?

A person can continue to receive palliative care as long as they have a serious medical condition. To qualify for hospice, however, someone has to have a life expectancy of six months or less. If they live beyond the expected six months, a physician can recertify that they are terminally ill so they can continue hospice care. Coverage depends on the person’s insurance.

What are the five stages of palliative care?

• Stage 1: A medical plan is set to monitor and manage your condition.
• Stage 2: A plan is established to address your emotional and spiritual needs.
• Stage 3: Your condition is in the early stages, but end-of-life issues may be addressed. You may continue to receive curative treatment for your condition.
• Stage 4: Your condition is recognized as late-stage or terminal, and care plans are adjusted accordingly. If you transition to hospice care, you will no longer seek curative treatment for your condition but will continue to receive comfort care and symptom management.
• Stage 5: In the event that you pass away, your family will be provided emotional, psychosocial, and spiritual support during their bereavement.

12 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.

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

Palliative care vs hospice: What’s the difference?

To help families find the right care for a loved one facing a serious illness, Tara Liberman, DO, explains what everyone should know about hospice and palliative care

Chronic and terminal illnesses are devastating. Naturally, families and caregivers want to help ease any suffering, but there is often confusion about how best to help during these difficult times, says Tara Liberman, DO, executive director of Northwell Health’s Hospice Care Network.

Palliative care and hospice are two options that can help patients and their families navigate a diagnosis like cancer, certain types of heart disease, dementia or other complex conditions. Both services are dedicated to enhancing quality of life and managing pain — physical, emotional, social and spiritual — but there are some key differences.

Geriatrics and Palliative Medicine

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To help connect families with the right kind of care at the right time, Dr. Liberman, explains what everyone should know about palliative care vs hospice.

“The main difference between palliative care and hospice is that palliative care is a subspecialty of medicine and can start at the time of diagnosis for advanced illnesses, whereas hospice is an insurance benefit available only to those diagnosed with a terminal illness and have less than six months to live,” she said. “But, whether you’re seeing a palliative care or a hospice specialist, the goal is always to identify the cause of someone’s discomfort, then find different ways to relieve that pain.”

Featured expert

Tara Liberman, DO

Executive director for Northwell Health’s Hospice Care Network.

A quick history of palliative care and hospice

In 1974, the first hospice in the United States was established in Branford, Connecticut — seven years after what is considered the first “modern hospice” opened in London. Recognizing the immense suffering of those living with and dying from serious illnesses, leaders of the hospice movement of the time broadened their focus to include not just physical pain, but the emotional, social, and spiritual dimensions of distress — which often go overlooked. This concept of “total pain” is a pillar of both hospice and palliative care programs today.

Also in 1974, the term “palliative care” was coined and later recognized as a distinct specialty in 1990 by the World Health Organization (WHO). Today, palliative care is offered in the hospital setting, outpatient clinics, and doctors’ officers as well as in the home. Hospice is one example of palliative care.

Hospice was established in 1980 as a Medicare benefit by the U.S. government.

What is palliative care

Palliative care is a subspecialty in medicine that allows for patients diagnosed with an advanced illness to be cared for throughout their illness with a special focus on managing symptoms of the disease and treatment, and improving quality of life. “Whether they’ve just been diagnosed, are in the middle of their treatment, or the end of their life, palliative care is an overarching support system that can help guide and treat patients with an advanced illness,” Dr. Liberman said.

Does Medicare cover palliative care?

Some types of palliative care are covered by Medicare Part B, Medicaid and some private insurance. Not all costs are covered. Find palliative care near you using the National Hospice and Palliative Care Organization.

Find hospice & palliative care services near you

Northwell Health offers personalized medical care and emotional comfort to patients and families facing the last stages of a life-limiting illness.

When should someone be offered palliative care

Patients can ask a healthcare provider to refer them to a palliative care specialist, but more often their doctor will make that suggestion. “And usually it’s for a disease that may either be advanced, and their symptoms have acutely changed the way that patient is living, like shortness of breath, pain, anxiety and other psychosocial issues,” she added. “That will prompt their care team to have that conversation with a patient.”

When someone is diagnosed with serious conditions like cancer, Alzheimer’s disease or heart failure, Dr. Liberman recommends that providers bring in palliative care specialists earlier. “This just adds another layer of support for a very vulnerable population facing a life-changing disease, as well as expertise and training that other care teams may not have at their fingertips.”

Studies suggest that early use of palliative care can not only improve the quality of life, but it can also even extend life. A 2010 study of patients with metastatic non-small cell lung cancer found that those who received palliative care soon after diagnosis lived longer despite receiving less aggressive care at the end of life, compared with another group who received the standard of care.

What’s the Difference Between Palliative Care and Hospice Care?

Both are meant to bring comfort and relief, but they differ in some important ways. To get the right kind of care in your situation, you need to have a good idea of what each service offers.

What Is Palliative Care?

This program aims to ease pain and help with other problems if your illness is serious but not considered to be life-threatening for now.

It helps people live with the symptoms of long-running things such as cancer, kidney disease or AIDS, or with the side effects of the treatments.

Palliative medicine doesn’t replace other treatments. It’s an addition that helps you and your family deal with things such as nausea, nerve pain, or shortness of breath.

If an illness makes it harder to work, play, get around, or causes depression, palliative care can address that, too. People have said they feel more in control of their lives as a result.

Even in cases where an illness is expected to be fatal, this type of care can help you live as active a life as possible.

What Is Hospice Care?

This is for people who have learned from doctors that they are not expected to recover from their condition. It’s about easing pain and helping families prepare for the end of life. Palliative care is part of that, but it’s just one part.

People in hospice care generally are expected to have less than 6 months to live. They’re often at home, where family members and professional caregivers look after them. But you could also choose a specialized center for hospice care. It’s also offered at many nursing homes and hospitals.

This kind of care can involve not only doctors and nurses, but also family members, clergy, counselors, or social workers who can address the grief of dying and emotions (such as anger, sadness, or regret) that often come with it.

Easing Your Pain

Both palliative care and hospice care offer medicines that can ease your pain.

Those can range from over-the-counter drugs such as ibuprofen to stronger relief with opioid medications such as oxycodone or morphine.

The misuse of opioids has become a big concern, and you or a loved one might not want to take them because you’re afraid of becoming addicted. This can be a particular worry if you’ve already had problems with drugs or alcohol. But you might be rejecting pain drugs needlessly.

Researchers say people who are prescribed opioids during these kinds of cases, and use them as directed, rarely become addicted to them. It’s OK to take them instead of suffering.

These drugs do have side effects such as drowsiness, nausea, and constipation. Those problems usually fade as your body gets used to the medication. Talk to your doctor about things you can do to help manage some of these side effects.Your doctor should be able to help you decide whether to start taking them and how much you need.

Will Insurance Help Pay for This?

Medicare, the federal health insurance program for seniors, pays all charges related to hospice care. So does Medicaid, the federal-state health program for the poor. Most private insurers cover it as well.

Palliative care is not as well-covered. Medicare and private insurers cover some medicines, but not others. You may want to check your policy or call your insurance company to find out.

Show Sources

Ballantyne, J. Current Pain and Headache Reports, August 2011.

Center to Advance Palliative Care

Meera, A. Indian Journal of Palliative Care, January 2011.

National Hospice and Palliative Care Organization

National Institute of Nursing Research

Prater, C., Primary Care Companion to The Journal of Clinical Psychiatry, 2002.

U.S. National Library of Medicine

World Health Organization