What’s the Difference Between Palliative Care and Hospice?

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.

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.

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.

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.

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.