Hospice and palliative care get used interchangeably in conversation, and the mix-up is expensive. They share a goal, comfort rather than cure, and hospice is technically one kind of palliative care. Under Medicare, though, they are two different products with two completely different bills.
Hospice is a bundled benefit under Part A. Palliative care is not a benefit at all. It is specialty care billed the way a cardiology consult is billed, service by service under Part B, with a deductible and coinsurance attached to each piece. This guide covers who qualifies for each, what you give up, where each is delivered, and what actually shows up in your mailbox. All figures here are 2026 Medicare amounts confirmed in September 2026.
What’s the Difference Between Hospice and Palliative Care?
Federal regulation defines palliative care at 42 CFR 418.3 as patient and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering, across the whole continuum of illness. Nothing in that definition mentions dying.
The National Institute on Aging states the practical version: hospice care is a specific type of palliative care provided in the final weeks or months of life. Palliative care itself is open to anyone with a serious illness, at any age, and can begin the day of diagnosis.
Here is the comparison that matters for your wallet.
| Question | Palliative care | Hospice |
|---|---|---|
| Who can get it | Anyone with a serious illness, any age, any stage | Someone certified terminally ill with 6 months or less to live |
| Prognosis requirement | None | Yes, certified by the hospice doctor and your regular doctor |
| Keep curative treatment? | Yes, alongside it | No, not for the terminal illness and related conditions |
| Which part of Medicare | Part B (and Part D for drugs) | Part A |
| How Medicare pays | Per visit, on the physician fee schedule | One bundled per diem paid to the hospice |
| What you pay | $283 deductible in 2026, then 20% coinsurance | $0 for covered hospice services |
| Prescriptions | Normal Part D or plan cost sharing | Up to $5 copay per symptom prescription |
| Equipment and supplies | Part B durable medical equipment, 20% coinsurance | Included in the per diem |
| Hospital stay | Billed separately, $1,736 Part A deductible in 2026 | Arranged by the hospice and covered |
| Paperwork to start | A referral, like any specialist | A signed Hospice Election Statement |
Who Qualifies for Each
Palliative care has no eligibility gate beyond a serious illness and a referral. The NIA lists heart failure, COPD, cancer, dementia and Parkinson’s disease among the conditions people commonly get it for, and it is explicitly not limited to older adults.
Hospice has a hard gate. Medicare.gov spells out the conditions: you must have Part A, your hospice doctor and your regular doctor (if you have one) must certify that you are terminally ill with a life expectancy of six months or less, you must accept comfort care instead of care to cure the illness, and you must sign a statement choosing hospice before any services begin.
Outliving six months does not end the benefit. Coverage runs as two 90-day benefit periods followed by unlimited 60-day periods, each requiring recertification. Our guide to how long you can stay on hospice covers the recertification and discharge mechanics.
Do You Have to Stop Curative Treatment?
For palliative care, no. For hospice, yes, but only for the terminal illness and conditions related to it.
The exact rule sits at 42 CFR 418.24(g). For the duration of a hospice election, the patient waives all rights to Medicare payment for hospice care from a different hospice, and for any Medicare services related to treating the terminal condition or a related condition, unless the designated hospice provides or arranges them.
Two things that rule does not do. It does not stop Original Medicare from paying for health problems unrelated to the terminal illness, though you owe the usual deductible and coinsurance on those. And it is not permanent: you can revoke hospice, go back to curative treatment, and re-elect later.
Because the line between related and unrelated is where surprise bills come from, ask for the addendum to your Hospice Election Statement. It lists every item, service and drug the hospice has decided is unrelated and will not cover, and your provider must give it to you within three to five days of the request.
Where Each One Is Delivered
Palliative care is delivered in hospitals, nursing homes, outpatient palliative care clinics and other specialty clinics, and at home, per the NIA. Much of it happens as an inpatient consult during a hospital admission, and a growing share happens by telehealth.
Hospice is not tied to a place either. Medicare.gov says you can usually get it in your home or in the facility where you live, including assisted living or a nursing home, and in an inpatient hospice facility if you meet certain conditions. Medicare does not pay room and board in any of those settings, which is the single largest gap in the whole benefit and the reason our hospice care cost guide leads with it.
How Each One Is Billed, and Why That Is the Real Difference
This is where the two diverge completely.
Hospice is a bundle. Medicare pays the hospice one all-inclusive daily rate that covers the team, the visits, the symptom drugs, the equipment and the supplies for the terminal illness. The patient is billed nothing for covered services. The only two out-of-pocket items are a copayment of up to $5 for each outpatient prescription for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care, which can never exceed the inpatient deductible. Our Medicare hospice benefit guide walks the four levels of care and the exclusions.
Palliative care is not a bundle. Each piece is billed on its own:
- The clinician visit goes on the physician fee schedule as an office, inpatient or telehealth evaluation and management service.
- Drugs go through Part D or your plan’s pharmacy benefit with their normal copays.
- Oxygen, a hospital bed or a wheelchair goes through Part B durable medical equipment at 20% coinsurance.
- A hospital admission is a separate Part A claim with its own deductible, $1,736 per benefit period in 2026.
So the palliative care patient pays the 2026 Part B annual deductible of $283, then 20% of the Medicare-approved amount on every service after that. CMS confirms both figures in its November 14, 2025 fact sheet and again in Medicare Learning Network article MM14279, which lists the CY2026 Part B deductible at $283 a year and Part B coinsurance at 20%. In practice that is roughly $19 to $38 out of pocket per palliative office visit once the deductible is met. Our palliative care cost guide prices every line.
If you have a Medigap policy, most plans pick up that 20%. If you have Medicare Advantage, the plan sets its own copay, often a flat specialist copay per visit, and network rules apply.
Does Medicare Cover Palliative Care?
Yes, but not as a program you enroll in. Medicare pays for the services a palliative care team delivers, under the ordinary Part B rules described above. There is no Medicare palliative care election form, no per diem, and no waiver of anything.
One piece does get special treatment. Medicare.gov states that Part B covers voluntary advance care planning as part of your Welcome to Medicare visit and your yearly Wellness visit, and that you pay nothing for it if your provider accepts assignment and it is done as part of those visits. If the same conversation happens as part of other medical treatment, the Part B deductible and coinsurance apply.
Medicaid and private plans vary. Many state Medicaid programs and many commercial and marketplace plans pay for palliative care visits under their normal outpatient or specialist rules, and some states have built dedicated community-based palliative care benefits. Check the plan document rather than assuming, and see what Medicaid covers for the general shape of the benefit.
Children Are the Exception: Concurrent Care
Adults on Medicare have to choose. Children on Medicaid and CHIP do not.
Section 2302 of the Affordable Care Act amended sections 1905(o)(1) and 2110(a)(23) of the Social Security Act to remove the prohibition on receiving curative treatment after electing hospice, for a Medicaid or CHIP eligible child. CMS explained the requirement to states in State Health Official letter 10-018, issued September 9, 2010.
The practical effect: states must make hospice available to children eligible for Medicaid and for Medicaid-expansion CHIP without the child forgoing any other Medicaid service for treatment of the terminal condition. States with standalone CHIP programs still choose whether to cover hospice at all, but if they cover it they must comply with the same rule. The provision was effective on enactment, March 23, 2010, and CMS applies it to individuals under 21.
A physician still has to certify that the child is within the last six months of life. What goes away is the tradeoff.
The Bottom Line
Palliative care is the wider door. No prognosis requirement, no waiver, available from diagnosis onward, delivered anywhere from a clinic to your kitchen table. The cost of that flexibility is that Medicare treats it like any other specialty care: a $283 deductible in 2026 and 20% of everything after it, plus separate bills for drugs, equipment and hospital stays.
Hospice is the narrower door with the better price. Six months or less, certified, and you waive Medicare payment for curative treatment of that illness. In exchange, the bundled per diem means $0 for covered services, a $5 cap per symptom prescription, and no equipment or supply bills for the terminal illness.
Most families end up walking through both, palliative care first and hospice later. If you are pricing the palliative side now, start with our palliative care cost guide. If you are close to a hospice decision, read who pays for hospice care and, if you are the caregiver, Medicare respite care. And if palliative care is being delivered at home, check whether the Medicare home health benefit covers part of it at no cost sharing, because that is the one place these two worlds overlap in your favor.