Hospice vs. Palliative Care: What's the Difference?
Hospice and palliative care both ease symptoms. They are not the same program. This page says who each one is for, and what Medicare covers.
Comparison chart
Print this chart and take it to a visit. The cells follow the National Institute on Aging and Medicare.gov. They are not a rule for one person.
| Palliative care | Hospice | Comfort care | |
|---|---|---|---|
| Who it is for | A person with a serious illness, at any stage. It can start at diagnosis. | A person a doctor believes is likely to live about 6 months or less if the illness follows its usual course. | Anyone whose main goal is ease and relief of symptoms. It is a goal of care, not its own Medicare program. |
| Can treatment to cure continue? | Yes. You can keep treatment aimed at the illness. | Under Medicare hospice, you choose comfort care instead of treatment to cure the terminal illness and related conditions. Care for unrelated problems can continue. | It depends on the plan you and the team agree to. Ask which treatments will continue. |
| Where it can happen | Hospital, clinic, nursing home, or home. | Usually home, including assisted living or a nursing home. A short inpatient stay is possible when the hospice arranges it. | Wherever the person is already receiving care. |
| Who pays | Medicare, Medicaid, and private insurance may cover it. What they pay depends on the plan and the services. | Medicare Part A covers hospice from a Medicare-approved hospice if you qualify. You pay nothing for covered hospice services. You may still pay up to $5 for each outpatient pain or symptom prescription, and 5% for inpatient respite care. Room and board in a nursing home are usually not covered. | There is no separate comfort-care benefit. Payment follows the setting, or the hospice benefit if you elect hospice. |
| How you start | Ask the doctor for a palliative care visit. | A hospice doctor and your doctor, if you have one, certify that you qualify. You sign a statement choosing hospice. | Tell the team you want the focus to be comfort. Ask them to say, in plain words, what will change. |
Sources for this chart: National Institute on Aging Opens in a new tab. and Medicare.gov hospice coverage Opens in a new tab.. By Richard, NP. This chart is general education, not medical or legal advice.
Palliative care can start early
Palliative care treats symptoms and stress from a serious illness. Pain, shortness of breath, nausea, and worry all count.
You do not have to give up treatment that might slow or cure the illness. The National Institute on Aging says palliative care can begin at diagnosis and can be given along with that treatment.
It can happen in a hospital, a nursing home, a clinic, or at home. A palliative care team may include a doctor, a nurse, a social worker, and others. Ask your own doctor who is available near you.
Hospice is comfort care near the end of life
Hospice is a type of palliative care for the last months of life. Medicare describes it as care for a person who is terminally ill, with a life expectancy of 6 months or less if the illness runs its normal course.
The 6 months is an estimate, not a deadline. If the person lives longer, hospice can continue when a hospice doctor recertifies that the person is still terminally ill. Medicare uses two 90-day periods, then 60-day periods, with no fixed end date.
Choosing Medicare hospice means you accept comfort care instead of care to cure the terminal illness and related conditions. You sign a statement that says so. Hospice is not only for cancer.
Hospice is usually given at home. It can also be given in assisted living or a nursing home. Medicare does not pay room and board there. If the hospice team arranges a short inpatient stay or respite care so a caregiver can rest, Medicare can cover that stay. Respite care can last up to 5 days at a time.
You can stop hospice at any time. You do not have to wait for a benefit period to end.
Comfort care is a goal, not a third program
People use comfort care to mean care aimed at ease, dignity, and relief of symptoms. Medicare uses those words to describe the focus of hospice. A hospital may use them for a plan that is not hospice.
If a clinician says comfort care, ask two questions. Which treatments will stop? Which treatments will continue, including pain medicine, oxygen, and antibiotics?
When it may be time to ask about hospice
Only a doctor can say whether hospice fits. Families often bring it up in two situations the National Institute on Aging and Medicare describe.
- Treatment to cure or slow the illness no longer seems to be helping, or it is causing more burden than benefit.
- A doctor has said the person may have about 6 months or less if the illness follows its usual course.
You can also call the doctor when someone is weaker, eating much less, or going to the hospital more often. Those changes are a reason to ask. They are not, by themselves, a rule that hospice has to start.
Questions to ask the doctor
Print this list and take it with you. You do not need to ask every question.
- Do you think it is time to look at hospice, or at palliative care while treatment continues?
- What treatment is still helping, and what is mostly causing burden?
- What would comfort look like at home?
- Would Medicare hospice cover this, and what would we still pay?
- Can we try hospice and stop if we change our minds?
- Who would be on the team, and how do we reach them at night?
Your state
Living will and health care power of attorney forms for your state.
All living will and health care power of attorney formsWatch a short video
Two short videos from LifeWishGuardian. They explain comfort and how this app approaches hard talks.
Comfort care and who decides
How comfort comes first near the end, and who can speak when a loved one cannot.
Our approach
A calm place to start, so a family can talk about care before a hard day arrives.
These videos are educational. They are not medical or legal advice.
Write down what comfort means to you
Write down what comfort means to you now, so your family knows your wishes if the time comes. Record them in LifeWishGuardian and share them with your family and doctor.
A video does not replace hospice, a DNR, or a POLST. Hospices and health plans can also ask about a branded version.
Questions families ask
What is the main difference between hospice and palliative care?
Both focus on comfort and quality of life. Palliative care can start at any stage of a serious illness, and you can keep treatment aimed at the illness. Hospice is for a person a doctor believes is likely to live about 6 months or less if the illness follows its usual course. Under Medicare hospice, the focus shifts to comfort, and treatment to cure the terminal illness stops.
Is comfort care the same as hospice?
No. Comfort care means easing pain and other symptoms. Hospice is one Medicare program that provides comfort care near the end of life, with its own rules. A hospital may also call a plan comfort care without a hospice election. Ask the team which treatments will stop and which will continue.
Does Medicare cover hospice and palliative care?
Medicare Part A covers hospice if you qualify and use a Medicare-approved hospice. Medicare says you pay nothing for covered hospice services. You may still pay up to $5 for each outpatient prescription for pain and symptom medicine, and 5% for inpatient respite care. Room and board in a nursing home are usually not covered. Palliative care is different. The National Institute on Aging says Medicare, Medicaid, and private insurance may cover it, and what they pay depends on your benefits and treatment plan.
Can you get palliative care at home?
Yes. The National Institute on Aging says palliative care can be given in a hospital, a nursing home, an outpatient clinic, or at home. What is available depends on the clinicians and agencies near you.
Can someone leave hospice?
Yes. Medicare says you can stop hospice at any time. The hospice will ask you to sign a form with the date hospice should stop. Treatment for the illness can start again under regular Medicare rules. If you still qualify later, you can choose hospice again.
How do families know when to ask about hospice?
Ask when treatment no longer seems to be helping, or when a doctor says the person may have about 6 months or less if the illness follows its usual course. That 6-month figure is an estimate, not a deadline. Only a doctor can decide if hospice is appropriate.
Sources
These pages use public pages from agencies and national programs. They do not invent statistics.