Hospice vs Palliative Care: What Families Should Know First

Palliative care is comfort and symptom care for anyone with a serious illness, at any stage, and your parent can get it while still treating the illness. Hospice is a specific kind of palliative care for the last stretch of life: under Medicare, a doctor certifies a life expectancy of six months or less, and your parent chooses comfort care instead of treatment meant to cure the terminal illness. Palliative care is billed like any other specialist visit. Medicare's hospice benefit covers almost everything related to the terminal illness, with only small copayments.

Families often hear both words for the first time in a hospital hallway, from a doctor with four minutes to spare. This guide is for reading before that day.

Hospice vs palliative care at a glance

The National Institute on Aging's overview of palliative and hospice care describes the usual path: palliative care can begin at diagnosis, and if treatment stops helping, it can shift into hospice or lean further toward comfort.

Palliative care: an extra layer, at any stage

Palliative care is a medical specialty. A team of doctors, nurses, social workers and often a chaplain or nutritionist works with your parent's other doctors on symptoms like pain, breathlessness and nausea, and on the stress of being sick. NIA's palliative care FAQ lists heart failure, COPD, cancer, dementia, Parkinson's and kidney failure among the illnesses where it helps, and is clear that using it doesn't mean someone is dying.

The part families miss: your parent doesn't have to give anything up. NIA's example is a woman with breast cancer whose palliative team treated her anemia so she could keep going with chemotherapy.

Where it happens and how it's paid for

NIA says palliative care is offered in hospitals, nursing homes, outpatient clinics and sometimes at home; what's available varies by area, so ask. The Center to Advance Palliative Care (CAPC) explains that palliative care is paid for like any other specialty, such as cardiology, and most insurance covers it, including Medicare, Medicaid and private plans. So expect your parent's usual specialist cost sharing, and check the network if they have a Medicare Advantage plan. NIA adds that veterans may be eligible through the VA.

How to ask for a referral

Palliative care usually starts with a referral. CAPC suggests asking the doctor treating the serious illness, such as the oncologist, cardiologist or neurologist. If nobody has mentioned it, your parent (or you, with their permission) can bring it up:

If your parent is in the hospital now, see what to do when an elderly parent is hospitalized.

Hospice: comfort care when the goal changes

NIA's hospice FAQ describes hospice as care for people who choose to stop treatment meant to cure or control their illness, because it's unlikely to work or has become too burdensome.

Who qualifies under Medicare

According to Medicare.gov's page on hospice care coverage, your parent must have Part A and meet all of these:

• The hospice doctor and their regular doctor (if they have one) certify they're terminally ill, with a life expectancy of six months or less.
• They accept comfort care instead of care to cure the illness and related conditions.
• They sign a statement choosing hospice instead of other Medicare-covered treatment for the terminal illness. This is the Hospice Election Statement, naming the hospice, start date and attending doctor. If your parent is physically or mentally unable to sign, federal rules (42 CFR 418.24) let a representative with authority under state law sign instead.

Notice what isn't on Medicare's list: a DNR order, being bedbound, or moving out of home. The hospice team will likely ask about resuscitation wishes, but that conversation is separate from qualifying.

The six months is an estimate, not a deadline. NIA points out that doctors have a hard time predicting how long an older, sick person will live.

What the hospice benefit covers

Medicare's official booklet, Medicare Hospice Benefits, lists what a hospice plan of care can include: doctor and nursing care, medical equipment like a walker or wheelchair, supplies, drugs for pain and symptoms, aide and homemaker services, therapy, social work, dietary counseling, grief counseling for the family, short-term inpatient care and short-term respite care. A hospice nurse and doctor are on call around the clock.

What your parent pays is small. The booklet says there's no deductible, a small copayment per prescription for pain and symptom drugs, and 5 percent of the Medicare-approved amount for inpatient respite care. If your parent has a Medigap policy, the booklet says it covers those drug and respite costs.

Two rights worth knowing about:

• A one-time planning visit. Before choosing hospice, your parent can get a one-time consultation with a hospice medical director or hospice doctor to talk through options and symptom management, even if they decide against hospice.
• The "unrelated" list. For hospice elections starting on or after October 1, 2026, the same federal rule requires the hospice to give your parent a written addendum, titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs," within the first 5 days of hospice care, without anyone having to ask. It lists what the hospice considers unrelated to the terminal illness and explains why, and the hospice must update it within 3 days if that changes. Signing it only confirms receipt, not agreement. (Medicare.gov's page may still describe the older ask-for-it rule.)

What hospice doesn't cover, and the call to make first

Once hospice starts, Medicare won't cover treatment meant to cure the terminal illness, care for it from providers the hospice didn't arrange, or room and board at home or in a nursing home. Treatment for unrelated problems continues: NIA's example is that someone with cancer in hospice still gets their blood pressure medicine.

The one that catches families: ER visits, hospital stays and ambulance rides related to the terminal illness are covered only if the hospice team arranges them. The Medicare booklet warns that otherwise your parent might have to pay the full cost. The American Cancer Society's guide to levels of hospice care puts it plainly: in an emergency at home, call hospice first, and they'll help decide whether to call 911.

The four levels of hospice care

CMS's hospice payment page defines four levels. Ask any hospice how it handles each:

Hospice at home isn't round-the-clock staffing. NIA notes that most of the daily care still comes from family and friends, with the team visiting and on call by phone. Our guide to respite care for caregivers covers the other places to find a break.

How long hospice can last

Medicare covers hospice in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. At the start of each period after the first, the hospice doctor must recertify that your parent is still terminally ill. Past six months, Medicare.gov says recertification follows a face-to-face visit with the hospice doctor or hospice nurse practitioner. Your parent doesn't have to re-elect hospice each time, and if they improve, they may be discharged and can come back later if eligible.

Choosing a hospice agency

Medicare covers hospice only from a Medicare-approved provider. The Medicare booklet suggests three places to start: your parent's doctor, Medicare's Care Compare tool, which lets you compare hospices on quality measures, and your state hospice organization (1-800-MEDICARE can give you the number). A Medicare Advantage plan must help your parent find one.

Then call two or three agencies and ask each the same questions:

• Are you Medicare-certified, and do you serve my parent's address or facility?
• How soon after a referral can someone visit and start care?
• When we call in the middle of the night, who answers, and how fast can a nurse come out?
• Do you provide continuous home care during a crisis?
• Where do your patients go for respite or general inpatient care?
• Will my parent's own doctor stay involved as the attending doctor?
• Which current medications would you stop covering as unrelated?
• What grief support do you offer the family, and for how long?

Be wary of anyone who comes to your parent first. The booklet warns about scammers who offer gifts or "free" housekeeping to sign people up for hospice they don't need, and reminds you that only a doctor can certify terminal illness.

Changing course: switching, stopping and live discharge

Hospice isn't a one-way door. The Medicare booklet spells out these rights:

• Switching agencies. Your parent can change hospice providers once in each benefit period.
• Stopping hospice. Your parent can stop at any time, for example to try a new treatment, and the hospice will ask them to sign a form with the end date. No one should hand your parent a form to stop hospice unless they asked, and they shouldn't sign or date it before the day they actually want care to end. In Original Medicare, regular coverage picks back up, and they can return to hospice later if they're still eligible.
• Live discharge. If the hospice decides your parent no longer qualifies because their condition improved and you disagree, your parent has the right to a fast review by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). The hospice should give a notice explaining how. If it doesn't, ask for it.

A parent leaving hospice who still needs a lot of help faces many of the same questions as after a hospital stay, so our hospital discharge checklist works here too.

Paperwork to have ready before either conversation

Neither kind of care requires a stack of legal documents, but decisions go faster when these are already found and copied:

• Advance directive. It records your parent's wishes and usually names who decides if they can't. Rules and forms differ by state; see our guide to advance directive forms by state.
• Health care proxy. The person who can make decisions if your parent can't, and often the one who signs the hospice election in that case. See health care proxy vs. power of attorney.
• POLST or out-of-hospital DNR. These are medical orders that paramedics can follow, unlike a living will. If your parent is seriously ill, ask the doctor about one now. Our guide to the POLST form explains the differences and where to keep it.
• Medicare and plan cards. Medicare, plus any Medicare Advantage, Medigap and Part D cards. Our list of Medicare documents to keep for a parent covers the rest.
• Current medication list and doctor list. The hospice will sort drugs into related and unrelated, and the palliative team needs the full picture.

Frequently asked questions

Can you have palliative care and hospice at the same time?

Hospice already includes palliative care: NIA calls hospice a specialized form of palliative care for the final months or weeks. The reverse isn't true. Most people getting palliative care aren't on hospice.

Does choosing hospice mean giving up all treatment?

No. Under Medicare, treatment meant to cure the terminal illness stops, but treatment for other conditions continues, and so does anything that keeps your parent comfortable. Your parent can also leave hospice to resume treatment.

Who decides when it's time for hospice?

Your parent decides, with their doctors. A doctor has to certify the six-month prognosis, and your parent signs the election statement, or, if they can't, a representative with authority under state law. NIA notes that many people start hospice only in the final weeks or days, and that starting earlier can bring months of support.

Before the conversation gets urgent

None of this has to be settled today. What helps most is having the papers found and the numbers written down before anyone says "hospice" out loud. You can pull it together yourself with this guide and an afternoon, or Emergency Binder Now can do the organizing from about 25 minutes of guided questions, producing a printable binder with an emergency sheet for paramedics, pages noting whether the advance directive, proxy and POLST exist and where they're kept, and a short list of what's still missing. You can see a sample binder first.

This article is general information, not medical, legal or financial advice. Hospice and palliative care decisions belong to your parent and their doctors, and coverage depends on their plan and state. For your parent's situation, talk with their doctor, their plan or 1-800-MEDICARE.