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

This page is for patients and families trying to understand the difference between palliative care and hospice. It covers who qualifies, what each provides, how each is paid for, and what to ask.

Palliative care and hospice are often confused. The difference is straightforward once you see it. Palliative care is comfort-focused care. NCI says it may be provided at any point during cancer care, from diagnosis to the end of life, and you may keep getting cancer treatment. Hospice begins when curative treatment is no longer the goal of care and the sole focus is quality of life. It requires a life expectancy of 6 months or less.

Palliative care has no timing requirement and no need to give anything up. NCI says it can start from diagnosis, and you may continue cancer treatment while receiving it. It focuses on symptoms and quality of life.

Hospice has stricter eligibility. Medicare says your hospice doctor and your regular doctor (if you have one) must certify a life expectancy of 6 months or less. Care can continue past 6 months if the hospice medical director recertifies. With hospice, the focus shifts to relieving symptoms and giving support rather than treatment aimed at cure. It is worth discussing carefully with your team. NCI says you can always stop hospice care.

Both use a team-based approach. NCI says a palliative care team may include doctors, nurses, dietitians, pharmacists, occupational and physical therapists, chaplains, psychologists, and social workers. They work with your cancer team.

NCI says hospice services include:

• medical and nursing services
• medical supplies and equipment
• drugs for managing cancer-related symptoms and pain
• short-term inpatient care
• volunteers
• counseling and spiritual care
• social work services
• grief counseling and support

Palliative care coverage depends on your insurance.

NCI says Medicare and most Medicaid and private insurance plans pay for hospice services. Medicare says there is no copayment for covered hospice services from Medicare-approved providers. There may be up to a $5 copayment for outpatient pain and symptom drugs, and up to 5% coinsurance for inpatient respite care. Room and board in a facility may not be covered. For palliative care, NCI says private insurance usually covers it, and Medicare and Medicaid pay for some kinds. Medicaid varies by state. If you are uninsured, NCI suggests talking with a social worker or hospital financial counselor.

Confusing the two can lead people to avoid palliative care. Some associate it with "giving up." In reality, NCI says it can start at diagnosis and you may continue cancer treatment. It can also lead people to delay asking about hospice. Ask your team early what hospice would offer.

• Would palliative care help me manage symptoms right now, even while I continue treatment?
• What would need to change for hospice to become the right option for me?
• If I choose hospice, what happens if I want to stop or go back to cancer treatment?
• What does each option cover under my specific insurance?

• National Cancer Institute — Hospice Care
• Medicare.gov — Hospice care
• National Cancer Institute — Palliative Care in Cancer