Palliative Care

Palliative Care vs Hospice Care: What Differs in Who Pays and When Each Starts

Palliative care can start at any stage of a serious illness, while hospice starts when life expectancy is six months or less. See who pays for each, what each costs, and how families move from one to the other.

Updated November 8, 2026 · 8-minute read

Key takeaways

Palliative care can start at any stage of a serious illness. A person can get it while still getting treatment aimed at a cure.
Hospice starts later. A doctor must find that life expectancy is 6 months or less if the illness runs its normal course (Ledger B1).
Palliative care is paid as medical care. A visit billed under Part B follows the usual rule: 20% of the Medicare-approved amount after the deductible, when the provider accepts assignment (Ledger A16).
Hospice has its own cost rules. There is no deductible. A patient pays up to $5 per outpatient prescription for pain and symptom control, and 5% of the Medicare-approved amount for inpatient respite care (Ledger A14).
A person can move from palliative care to hospice when the facts change. The move is a change of benefit, not a failure of the first kind of care.
Under hospice, Medicare stops paying for care meant to cure the terminal illness. Care for other health problems still goes through regular Medicare.

Two words cause a lot of fear at a hospital bedside: palliative and hospice. Many families hear palliative and think it means hospice. They hear hospice and think it means all care stops that day. Neither is true. Both kinds of care focus on comfort, pain control, and quality of life. They differ in when they can start and in who pays for what. This guide sets out the line between them in clear terms, so a family can ask for the right help at the right time. Our palliative care section holds more guides on care for serious illness.

What palliative care is

Palliative care is care for the symptoms and stress of a serious illness. The team works on pain, breathlessness, nausea, poor sleep, and worry. They also help a patient sort out treatment choices and state what matters most to them.

A palliative team often includes a doctor, a nurse, and a social worker. The team works alongside the doctors who treat the illness itself. A person with heart failure can get palliative help while still getting heart drugs, hospital care, and tests. A person with cancer can get it during chemotherapy. There is no rule that treatment must stop first.

Palliative care can be given in a hospital, in a clinic, or at home in some programs. Ask the treating doctor for a referral if symptoms are hard to control or if the family faces hard choices about next steps.

What hospice care is

Hospice is a Medicare benefit for the last stage of a terminal illness. It is care for comfort when a cure is no longer the goal. Most hospice care is given at home by a hospice team that visits on a set plan. It can also be given in a nursing home or a hospice unit.

To elect hospice, a doctor must certify that life expectancy is 6 months or less if the illness runs its normal course (Ledger B1). The patient signs an election statement. From that date, the hospice is in charge of care related to the terminal illness.

Hospice covers a team, drugs for pain and symptom control tied to the terminal illness, medical supplies, and short inpatient stays for symptom control or respite. Our hospice revoking guide, in the hospice section, shows how a person can stop hospice, return to regular Medicare, or change hospices if they change their mind.

When each one starts

Timing is the core difference.

Palliative care has no prognosis test. It can start at diagnosis of a serious illness, in the middle of treatment, or late in the course of the illness. The test is need: symptoms that are hard to bear, stress that is hard to carry, or choices that are hard to make.

Hospice has a prognosis test. The 6-month finding in Ledger B1 must be made and certified. A person who may live well past that point does not yet qualify, even if they are very sick. That person can still get palliative care.

Families often wait too long to ask about hospice because they wait for a doctor to raise it. If a loved one is in and out of the hospital, losing weight, and spending most of the day in bed or a chair, ask the doctor directly whether the B1 test could now be met.

Who pays for what

Original Medicare pays for palliative care as medical care. Doctor and clinic visits fall under Part B, and the usual Part B rule applies: 20% of the Medicare-approved amount after the deductible, when the provider accepts assignment (Ledger A16). Hospital stays fall under Part A rules.
Original Medicare pays for hospice under Part A once a person elects it and meets the B1 test. Hospice patient costs are set by Ledger A14: no deductible, up to $5 per outpatient prescription for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care.
If a person in a Medicare Advantage plan elects hospice, Original Medicare pays for the hospice care. The plan still covers care that is not related to the terminal illness, under its own rules.
Part D pays toward covered drugs outside the hospice benefit. Drugs for pain and symptom control tied to the terminal illness are covered by the hospice itself, not by Part D.
A Medigap policy pays toward cost sharing for care Original Medicare covers. It does not add a hospice or palliative benefit of its own.
Medicaid can help people who qualify under state tests. In a nursing home, Medicaid rules and hospice rules can apply at the same time, with the state program handling room and board in set cases. Ask the state Medicaid office and the hospice how they split the bill.
Private pay covers what no program covers, such as extra private aide hours at home beyond the hospice visit plan.

How the two fit together

Think of palliative care as the wider door and hospice as a room inside it. All hospice care is palliative in aim, since it works for comfort. Not all palliative care is hospice, since palliative care can run next to curative treatment for months or years.

A common path looks like this. A man with advanced lung disease gets palliative visits for breathlessness while he still takes treatment for the disease. Over time the treatment stops helping and hospital stays grow more frequent. His doctor can now certify the 6-month finding. He elects hospice, the hospice team takes over care tied to the lung disease, and he keeps seeing regular Medicare doctors for his other health problems.

No new referral hunt is needed at that point in most cases. The palliative team can help the family pick a hospice and make the handoff.

Myths that cause delay

One myth says hospice means giving up all medical care. It does not. It means giving up care meant to cure the one terminal illness, in trade for a team built for comfort. Care for a broken bone, an infection from another cause, or a long-term drug for a second illness still goes on.

A second myth says palliative care is only for cancer. It is for any serious illness: heart failure, lung disease, kidney failure, dementia, and stroke among them.

A third myth says a person who lives past 6 months must leave hospice at once. The finding is a prognosis, not a deadline. Hospices review patients in set periods, and a person who still meets the test can stay on the benefit. A person who gets better can revoke the election and return to regular Medicare.

Questions to ask the care team

Are my symptoms the kind a palliative team can help with now?
Which of my treatments are aimed at a cure, and which are aimed at comfort?
If I asked today, could a doctor certify that my life expectancy is 6 months or less if the illness runs its normal course?
If I elect hospice, which drugs and visits does the hospice cover, and what would I pay under the hospice cost rules?
Who do I call at night if pain or breathlessness gets worse, under each kind of care?

Sample situation

Ruth is 79 and has severe heart failure. She has been in the hospital three times this year for fluid build-up and hard breathing. She still takes her heart drugs and wants to keep trying treatment. Her cardiologist refers her to a palliative team. The team adjusts her drugs for breathlessness, helps her set limits she wants for future hospital stays, and visits her in clinic each month. Her visit costs follow the Part B rule of 20% after the deductible. Eight months later, Ruth is weaker, sleeps in a chair, and no longer gains from hospital stays. Her doctor certifies that her life expectancy is 6 months or less if the illness runs its normal course. Ruth elects hospice. A hospice nurse now visits at home, her pain and breath drugs cost no more than $5 per prescription, and her daughter gets a short respite stay for her at 5% of the approved amount. Ruth did not make two hard choices. She made one choice twice, as her facts changed.

Steps to take this week

Both kinds of care exist to ease the hard part of a serious illness. Palliative care can start early and run next to treatment. Hospice starts when the illness is in its last stage and a doctor certifies the 6-month finding. Knowing which door is open at which time lets a family ask for help as soon as help exists.

Write down the symptoms that are hardest to bear. Bring the list to the next visit.
Ask the treating doctor for a palliative care referral if symptoms or stress are high.
Ask plainly whether the 6-month hospice test could be met now or soon.
If hospice fits, ask two or three hospices what their visit plan and night cover look like before you elect one.
Keep a note of which drugs and services each kind of care covers, so bills can be checked later.