Palliative Care vs. Hospice Care: The Differences, Who Pays, and When to Switch

Palliative care treats the symptoms and stress of a serious illness at any stage, alongside treatment meant to cure or control the disease, with no time limit. Hospice care is comfort-focused care for a person whose physician expects six months or less to live and who has chosen comfort over curative treatment. Hospice is one kind of palliative care, built for the final phase of life and paid almost entirely by the Medicare Hospice Benefit under Part A.

This guide serves two readers. Families get the plain differences, the costs, and the signs that it is time to talk about hospice. Clinicians, palliative programs, and hospice teams get the handoff: the certification narrative, the election statement, the ICD-10 and billing codes, and the deadlines that start the moment a patient elects. For the full eligibility rules by diagnosis, start with our hub on how Medicare determines hospice eligibility.

By the Hathr.AI Editorial Team. Last updated October 20, 2026, to reflect the FY 2027 Hospice Final Rule (CMS-1851-F), effective October 1, 2026. Hathr.AI builds HIPAA-compliant AI that hospice and palliative care teams use to review records and draft eligibility documentation. This guide is general education, not medical, legal, or billing advice. Confirm coverage with Medicare or your insurer, and care decisions with your clinicians. Example clinical notes below are illustrative composites, not real patient records.

Key takeaways

• Palliative care has no prognosis requirement and continues alongside curative treatment; hospice requires a physician to certify a prognosis of six months or less.
• Medicare pays for palliative care visits under Part B, with a $283 deductible in 2026 and 20% coinsurance; the Medicare Hospice Benefit under Part A covers nearly all hospice costs tied to the terminal illness.
• The median Medicare hospice stay was 19 days in 2024, and more than a quarter of hospice decedents enrolled only in the last week of life, according to MedPAC.
• As of October 1, 2026, hospices must give every Medicare patient the election statement addendum that lists items and conditions the hospice will not cover.
• Hathr.AI lets hospice and palliative teams run a whole chart, 100,000+ pages across 90+ files, through HIPAA-compliant AI with a signed BAA at signup, $47 per user per month, and a 7-day free trial.

Palliative care vs. hospice care chart: the differences side by side

The table below compares palliative care and hospice care on the ten factors families and referring clinicians ask about most.

Is palliative care the same as hospice?

Palliative care and hospice care share a philosophy but differ in timing and scope. Palliative care is the broad category: whole-person comfort care for anyone with a serious illness. Hospice is the branch of palliative care reserved for the last months of life, once the goal shifts to comfort alone and a physician certifies the prognosis. Every hospice patient receives palliative care. Most palliative care patients are not in hospice, and many never need it.

The phrase "hospice and palliative care" appears together so often because the same specialists train in both. The medical subspecialty is Hospice and Palliative Medicine, and many hospices run a separate palliative program for patients who are not ready, or not eligible, for hospice.

The two questions that decide which care you need

Almost every real distinction between palliative and hospice care comes down to two questions.

Question 1: What is the goal of care right now? If you still aim to cure or control the disease with active treatment, palliative care fits and hospice does not. If you now aim to maximize comfort and the quality of the time left, both fit, and hospice brings a larger benefit.

Question 2: Which way is the illness moving? Nobody can name a date. You can see the trend line. A serious illness that treatment holds steady points toward palliative care. A documented decline that treatment no longer reverses points toward hospice.

A person can receive palliative care for years while treatment works, then move into hospice in the months when it stops working. The philosophy stays the same. The goal and the trajectory change.

What is palliative care, and who should be offered it?

Palliative care adds a specialist team to your existing care. That team manages the burden of the illness itself: pain, breathlessness, nausea, fatigue, anxiety, depression, and the hard decisions that come with a serious diagnosis. You keep your oncologist, cardiologist, or nephrologist, and you keep any treatment aimed at the disease. Palliative care serves people with cancer, heart failure, COPD, kidney disease, Parkinson's disease, ALS, dementia, and other serious illnesses, at any age.

Clinicians should offer palliative care when the burden of the illness, or of its treatment, starts to outweigh what the patient can manage alone. Common triggers include:

• Two or more hospitalizations or emergency visits for the same condition in six months
• Symptoms that stay uncontrolled despite standard treatment
• A new diagnosis of metastatic cancer, advanced heart failure, or another life-limiting illness
• Treatment decisions that the patient and family find confusing or conflicting
• Caregiver strain that threatens the patient's ability to stay at home
• A "no" answer to the surprise question: would you be surprised if this patient died in the next 12 months?

Many hospitals screen for these triggers at admission. Palliative care happens in hospitals, outpatient clinics, nursing facilities, and at home. To find a program near you, the Center to Advance Palliative Care keeps a public directory at getpalliativecare.org.

Is palliative care bad? Does palliative care mean death?

Palliative care does not mean death, and the best evidence links it to better outcomes. In a 2010 trial in the New England Journal of Medicine, Temel and colleagues gave patients with metastatic non-small-cell lung cancer early palliative care alongside standard oncology. Those patients reported better quality of life and less depression, and they lived a median of 11.6 months compared with 8.9 months for patients who received standard care alone.

The fear behind this question usually comes from one experience: a family member referred to palliative care in the last days of life, when the team could do little more than manage the dying. That pattern reflects a late referral. Palliative care works best when it starts early, while there is still time to control symptoms, plan, and keep the person out of the hospital.

Common myths, corrected:

• "Palliative care means giving up treatment." Palliative care runs alongside treatment. Hospice is the option that sets curative treatment aside.
• "Hospice is a place." Hospice is a service that comes to wherever the patient lives, most often their own home.
• "Hospice is for the last few days." Medicare built the benefit for up to six months and longer through recertification.
• "Choosing hospice is permanent." A patient can revoke hospice at any time, return to curative treatment, and re-elect later.
• "Hospice speeds up death." Hospice neither hastens nor postpones death. Its staff treat pain and symptoms so the time left is as comfortable as possible.

What is hospice care, and how does the Medicare benefit work?

Hospice care is comfort-focused care for a person with a terminal illness, delivered by an interdisciplinary team and organized around the patient's and family's goals. Under Medicare, which sets the standard most insurers follow, a person qualifies when a physician certifies a prognosis of six months or less if the illness runs its normal course, and the patient elects hospice in place of curative treatment for that illness.

The mechanics that decide how the benefit works:

• Benefit periods. Two periods of 90 days, then an unlimited number of 60-day periods. A physician must recertify the prognosis at the start of each period.
• A face-to-face encounter. Before the third benefit period, and before every period after it, a hospice physician or nurse practitioner must see the patient no more than 30 days before the recertification and attest to it. Medicare allows this visit by two-way audio-video telehealth through December 31, 2027. See our guide to the hospice face-to-face encounter.
• The election statement and addendum. The patient signs an election statement that acknowledges the comfort-focused nature of hospice. Under the FY 2027 Hospice Final Rule, hospices must now give every Medicare patient the election statement addendum, which lists the conditions, drugs, and services the hospice considers unrelated to the terminal illness and will not cover.
• Revocation and discharge. A patient can revoke hospice in writing at any time. A hospice discharges a patient who stabilizes and no longer meets the criteria; that patient can re-elect later if they decline.
• Medicare Advantage. If you have a Medicare Advantage plan, Original Medicare pays the hospice. The CMS demonstration that let some Advantage plans cover hospice ended December 31, 2024.

Electing hospice changes what the care is trying to do. It does not lock the door behind you.

What happens if a hospice patient lives longer than six months?

A hospice patient who lives longer than six months stays on hospice as long as a physician recertifies, at each benefit period, that the prognosis is still six months or less. Medicare sets no lifetime cap on how long one patient can receive hospice. The six-month rule describes the expected course of the illness when the physician signs, and people with dementia, heart failure, and COPD often outlive that estimate while still declining.

Two things change for a long stay. From the third benefit period on, a hospice physician or nurse practitioner must see the patient, in person or by audio-video telehealth through 2027, within 30 days before each 60-day period. And the recertification narrative has to show continued decline, with numbers, since the last period. If the patient improves and the physician can no longer certify, the hospice discharges the patient, who keeps full Medicare coverage and can re-elect hospice later. For the hospice itself, long stays also count against the Medicare aggregate cap, set at $36,174.75 per beneficiary for FY 2027.

Most people reach hospice too late: what the data shows

MedPAC, the commission that advises Congress on Medicare payment, reported that 1.82 million Medicare beneficiaries received hospice care in 2024 and that 52.9% of Medicare decedents used hospice. The median length of stay was 19 days. More than a quarter of hospice decedents enrolled only in the last week of life. The average lifetime stay, 99.6 days, runs much higher because a smaller group of patients, often with dementia, stays for many months.

Those numbers describe a benefit built for six months that most families use for two or three weeks. We think the six-month prognosis is the wrong first question for a family. The better first question is whether the illness is on a documented downward trajectory that treatment no longer bends. Clinicians can often see that trajectory months before a crisis forces the decision.

Three forces delay the conversation. Prognosis is hard to call, so clinicians hesitate to name a timeline. Many families still hear "hospice" as surrender. And the documentation needed to support eligibility takes enough work that a team with a thin chart finds it easier to wait. The last two forces have nothing to do with medicine, which means a family and a care team can fix them.

Palliative care vs. comfort care vs. end-of-life care

Comfort care and end-of-life care describe goals; palliative care and hospice describe services. The terms overlap, and hospitals use them in different ways, so ask your care team which one they mean.

A patient on comfort measures in a hospital who goes home without enrolling in hospice loses the nursing visits, equipment, drugs, and 24-hour phone line the Hospice Benefit provides. If comfort care is the plan, ask whether hospice should be too.

What triggers the hospice conversation, by condition

Medicare Administrative Contractors publish Local Coverage Determinations (LCDs) titled Hospice Determining Terminal Status that describe the clinical signs supporting a terminal prognosis. The signs below come from those LCDs and show what a reviewer expects to find in the record. Each one is a pattern, and the pattern often shows up in the chart weeks to months before a crisis.

• Dementia. FAST stage 7 or beyond with all of the stage's features: unable to walk, dress, or bathe without help; urinary and fecal incontinence; and no consistent meaningful speech (about six intelligible words or fewer). The record also needs one serious complication in the past 12 months: aspiration pneumonia, sepsis, upper urinary tract infection, multiple stage 3 or 4 pressure ulcers, recurrent fever after antibiotics, or inability to maintain fluid and calorie intake shown by 10% weight loss over six months or serum albumin under 2.5 g/dL. See hospice eligibility for dementia and all seven FAST stages.
• Heart failure. NYHA Class IV symptoms at rest despite optimal treatment, often supported by an ejection fraction of 20% or less. Repeated hospitalizations strengthen the clinical picture in practice, though the LCD does not list them as a criterion. See hospice eligibility for heart failure.
• COPD and advanced lung disease. Disabling breathlessness at rest with poor response to bronchodilators, supported by markers such as FEV1 under 30% of predicted, resting oxygen saturation of 88% or less on room air, or pCO2 of 50 mmHg or more, with recurrent respiratory hospitalizations. See hospice eligibility for COPD.
• Cancer. Metastatic disease at presentation, or progression despite treatment, or a decision to stop treatment, together with declining function. The LCDs' general baseline for any diagnosis is a Karnofsky or Palliative Performance Scale score below 70% plus dependence in two or more activities of daily living.
• Kidney disease. A decision not to start or to stop dialysis, with laboratory evidence of advanced failure, such as a creatinine clearance under 10 mL/min (under 15 with diabetes) or serum creatinine over 8.0 mg/dL (over 6.0 with diabetes). Thresholds vary by Medicare Administrative Contractor.
• Any diagnosis. Decline in function, weight, or intake across visits; more frequent hospitalizations; and a rising need for help with daily activities. Medicare does not accept debility or adult failure to thrive as a principal hospice diagnosis, so the record must tie the decline to a specific terminal condition.

When the pattern is plain and nobody has raised hospice, look at the documentation first. That is where the lag usually sits.

Does Medicare cover palliative care?

Yes. Medicare covers palliative care under Part B as ordinary medical care, visit by visit, with no special palliative benefit. In 2026 you pay the $283 Part B deductible, then 20% of the Medicare-approved amount for each visit, unless a Medigap or other secondary plan picks up the coinsurance. Hospital palliative consults during an inpatient stay fall under Part A for the facility and Part B for the clinician. Drugs you take at home run through Part D.

Who pays for palliative care outside Medicare:

• Medicare Advantage. Covers palliative visits as medical care; some plans run home-based palliative programs with lower cost sharing.
• Medicaid. Covers physician and nursing visits; a growing number of states fund community palliative programs.
• Private insurance. Covers palliative consults as specialist visits, subject to your plan's copays.
• Advance care planning. Medicare pays clinicians for advance care planning conversations (CPT 99497 and 99498). When the conversation happens during the Annual Wellness Visit, Medicare waives your deductible and coinsurance for it.

Home-based palliative care costs more out of pocket than home hospice because no single benefit bundles the visits, equipment, and drugs. Ask any program what your plan pays before the first visit. In its FY 2027 hospice rule, CMS asked for public comment on expanding community palliative care under current Medicare benefits, but it did not change coverage.

Who pays for hospice care at home?

For most people, the Medicare Hospice Benefit pays for nearly all home hospice care related to the terminal illness, with little or no out-of-pocket cost. The table compares the main payers.

The details families ask about most:

• Is hospice at home free? For Medicare beneficiaries, it comes close for services tied to the terminal illness.
• Room and board. In your own home, there is no room and board charge. In a nursing home or assisted living facility, the Hospice Benefit pays for hospice services but not the facility's daily room and board. For patients on Medicaid in a nursing facility, Medicaid can cover room and board.
• What is not covered. Treatment meant to cure the terminal illness, and anything the hospice lists on the election statement addendum as unrelated. Care for unrelated conditions continues under regular Medicare.
• The requirement. Care must come from a Medicare-certified hospice. See the official rules at medicare.gov.

Hospice care at home and palliative care at home: what a week looks like

Most hospice care in the United States happens at home. A hospice does not station a nurse in the home around the clock. The interdisciplinary team visits on a schedule matched to need, family or hired caregivers provide hands-on care between visits, and the hospice answers the phone 24 hours a day. The team usually includes:

• A hospice physician or medical director who oversees the plan of care
• Registered nurses who manage symptoms and medications
• Home health aides who help with bathing and personal care
• Social workers who handle emotional, practical, and financial concerns
• Chaplains who offer spiritual support of any faith or none
• Volunteers and bereavement counselors who support the family before the death and for up to a year after it

Medicare defines four levels of hospice care, and a patient moves between them as needs change. Routine home care is the standard level. Continuous home care brings nursing-led care into the home for short periods during a crisis to avoid a hospital stay. Inpatient respite care gives caregivers up to five days of relief at a time. General inpatient care moves the patient to a facility when symptoms cannot be controlled at home. The hospice delivers the hospital bed, oxygen, and comfort medications to the door.

Home-based palliative care looks different. A palliative clinician or nurse visits every few weeks, or by video, to adjust symptom medications and update goals of care, while the patient keeps seeing their specialists. Home palliative programs are less available than home hospice, so ask your doctor or local hospital which ones serve your area.

Can you get hospice in a nursing home or assisted living?

Yes. A resident of a nursing home or assisted living facility can elect hospice, and the hospice team visits the facility the same way it would visit a private home. The facility staff provide daily care, and the hospice adds its nurses, aides, social worker, chaplain, drugs, and equipment for the terminal illness. The two organizations share one coordinated plan of care.

The cost difference is room and board. The Medicare Hospice Benefit does not pay the facility's daily rate. A resident who pays privately keeps paying it. A resident on Medicaid in a nursing facility keeps Medicaid coverage for room and board, which the state routes through the hospice to the facility. Ask the facility and the hospice to explain the billing in writing before the election.

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

Under Medicare, an adult who elects hospice receives palliative care from the hospice team, so a separate palliative program usually steps back. The patient cannot receive curative treatment for the terminal illness while enrolled. Care for unrelated conditions continues under regular Medicare, and the patient keeps their own attending physician if they choose.

Children follow a different rule. Section 2302 of the Affordable Care Act requires Medicaid and CHIP to cover curative treatment alongside hospice for patients under 21, a model called concurrent care. Medicare tested concurrent care for adults in the Medicare Care Choices Model, which ended in 2021 without becoming a permanent benefit.

For clinicians and hospice teams: how to transition a patient from palliative care to hospice

Families picture the move to hospice as one conversation. For the palliative team and the receiving hospice, it is a sequence with fixed deadlines, and each step produces a document a reviewer can request later. The table lays out the sequence.

Two parts of the sequence decide most audits: the certification narrative and the evidence behind it. Our hospice eligibility checklist walks through each item, and the NOE timely filing guide covers the five-day rule. For the quality reporting side, see what hospices need to know about HOPE.

What does a defensible certification narrative contain?

A defensible hospice certification narrative names the specific clinical findings that support a prognosis of six months or less, and at recertification it shows how those findings changed since the last period. Under 42 CFR 418.22, the certifying physician must compose the narrative from the patient's own clinical circumstances; check boxes and standard language do not qualify. The same dementia patient, documented two ways (illustrative composites, not real records):

The split holds across diagnoses. A thin heart failure note reads "CHF, declining, recertify." A defensible one reads: "NYHA Class IV with dyspnea at rest despite maximized guideline-directed therapy, EF 15%, three decompensation admissions in four months, now needs help with dressing and bathing, Palliative Performance Scale 40%." The first note asserts a conclusion. The second shows the evidence the LCD asks for: the functional stage and its change, a qualifying complication, the weight trend, the wound, the intake.

We take a firm position here: "continues to decline" is an opinion, and opinions do not survive an Additional Documentation Request. For more worked examples, see our hospice recertification narrative examples and the guide to writing an eligibility narrative that survives audit.

Which ICD-10 code is used for palliative care?

The ICD-10-CM code for palliative care is Z51.5, Encounter for palliative care. Coders report Z51.5 to show that a palliative care service took place. Z51.5 does not describe why the patient needs care, so coders also report the underlying serious illness, typically listed first. Hospitals and payers use Z51.5 to track palliative encounters.

Hospice claims follow stricter rules. The principal diagnosis on a hospice claim must be the terminal condition that supports the prognosis. CMS returns hospice claims that list debility (R53.81), adult failure to thrive (R62.7), or certain dementia codes that require an underlying condition coded first as the principal diagnosis. Under ICD-10-CM guidelines, a symptom code should not be principal once a related definitive diagnosis is established. Hospices also report the related secondary conditions that contribute to the prognosis, which is one reason the election statement addendum and the claim diagnoses need to agree.

How do clinicians bill for palliative care and advance care planning?

Palliative care clinicians bill Medicare Part B with the standard evaluation and management (E/M) codes for the setting: office, home, nursing facility, or hospital. Physicians, nurse practitioners, physician assistants, and clinical nurse specialists can bill. Visits that run long can add prolonged service time where the E/M rules allow it.

• Advance care planning. CPT 99497 covers the first 30 minutes of a face-to-face advance care planning conversation, and 99498 covers each additional 30 minutes. A clinician can bill them on the same day as an E/M visit. The patient's agreement to the conversation, the participants, the time spent, and what was decided all belong in the note. Add modifier 33 when the conversation is part of the Annual Wellness Visit so Medicare waives cost sharing.
• After hospice election. A patient's own attending physician who is not employed by the hospice bills Part B for professional services related to the terminal illness with the GV modifier. Any clinician treating a condition unrelated to the terminal illness bills with the GW modifier. Hospice-employed physicians bill through the hospice.
• Documentation that pays. Time-based codes fail review when the note lacks start and stop times or a total. Goals-of-care notes fail when they record a code status change without the conversation that produced it.

Palliative programs that bill visit by visit live or die on documentation volume. The same chart review that supports a hospice referral also supports the E/M level and the advance care planning claim.

Where documentation breaks down, and where HIPAA-compliant AI fits

The evidence a defensible note needs usually sits in the chart already. It is spread across a 140-page hospital discharge packet, faxed nursing home notes, handwritten visit records, and the prior certification. A clinician with 20 patients on service does not have time to read all of it before each recertification, so the narrative falls back on "continues to decline."

A general-purpose AI chat tool could find that evidence, but a compliance officer will forbid pasting PHI into one that has no BAA, and they are right to. The policy memo telling staff to stop pasting charts into ChatGPT does not stop the pasting. Giving the team a tool that does the same job and is allowed does.

Hathr.AI is that tool. Hathr.AI is a HIPAA-compliant AI platform that runs Anthropic's Claude models in AWS GovCloud (US), hosted on FedRAMP High infrastructure. Every Hathr.AI web app account includes a signed Business Associate Agreement, accepted electronically at signup. Hathr.AI never uses customer data for model training or product development. For a hospice or palliative team, that means you can upload the real record:

• The whole longitudinal chart. Each account's File Library stores and processes 90+ files and 100,000+ pages in a single workflow, so the hospital packet, the prior certifications, and the visit notes sit in one place.
• Scanned and handwritten records. Built-in OCR, including handwriting recognition, reads the faxed and scanned pages that text-only tools skip.
• Answers grounded in the source. Retrieval-augmented generation ties each finding to the document it came from, so the physician can check the FAST stage, the weight trend, and the admission dates against the page before signing.

A first session that works in about ten minutes: upload a referral packet and the last 60 days of visit notes, ask Hathr.AI to list the LCD criteria the record supports with page citations, then ask for a draft certification narrative that compares the current findings with the prior period. The physician edits and signs. Hathr.AI surfaces the evidence; the clinician makes the eligibility decision.

One limit worth stating plainly: Hathr.AI does not replace your EHR or your hospice software. If your EHR vendor offers AI features under its own BAA, those may suit in-the-moment charting. Hathr.AI fits the cross-document work: reviewing a full record against criteria, preparing an ADR response, or drafting the narrative from evidence spread across files your EHR never ingested. For the full workflow list, see Hathr.AI for hospice and our review of ChatGPT risks in hospice documentation.

What should a hospice or palliative team ask before using AI on patient records?

Before any team member uploads protected health information to an AI tool, the compliance officer should get written answers to these questions:

1. Is a Business Associate Agreement signed before the first upload? A BAA that arrives after weeks of procurement leaves staff using the unapproved tool in the meantime.
2. Where does the data run? Ask for the hosting environment by name and whether data ever crosses the commercial internet.
3. Does the vendor train models on your data? Get the answer in the contract, not on a marketing page.
4. Can it read your actual records? Test it on a scanned, faxed, handwritten packet of 100+ pages, not a clean typed note.
5. Does every finding cite its source page? A clinician needs to verify before signing.
6. Does a clinician sign off? The tool should draft and surface; the physician certifies.
7. Are there seat minimums? A plan that starts at 20 or 50 seats leaves a small hospice or palliative practice out.

Hathr.AI's answers to all seven: a BAA at signup, hosting on FedRAMP High infrastructure in AWS GovCloud, no training on customer data, OCR for scanned and handwritten records, source-grounded answers, clinician sign-off, and no seat minimums, with details on the pricing page. Hathr.AI Enterprise adds SAML single sign-on through Microsoft Entra ID or Google Workspace and SCIM provisioning for larger hospice networks.

Signs it may be time to consider a change

No single sign settles it, but signs tend to cluster. Consider palliative care when symptoms are hard to control, when treatment side effects are wearing down daily life, or when decisions are getting complicated. Consider raising hospice when several of these appear together:

• Treatment has stopped working, or its burdens clearly outweigh its benefits
• Hospital stays, emergency visits, and infections are coming closer together
• The person rests most of the day, eats less, and is losing weight or strength
• The person needs help with bathing, dressing, or walking that they did not need a few months ago
• The family's focus is moving from length of life to the quality of the time left

Raising hospice early expands options. It gives the family time to plan on their own terms instead of in a crisis, and given a 19-day median stay, that time is the most valuable thing this guide can offer.

How to talk to the doctor about palliative care or hospice

Start with the two questions: what is the goal of care, and which way is the illness moving? Then bring these questions to the appointment:

• Would a palliative care team help with the symptoms we are dealing with now?
• Is the current treatment still working, and is it worth its side effects?
• If things continue on this path, what do you expect over the next six months?
• Would you be surprised if my family member died in the next year?
• If we chose hospice, what would the team do, and what would our family do?
• What will each option cost us under our plan?

The answer often changes over time. Revisit the questions after every hospitalization or major change.

Frequently asked questions

What is the main difference between hospice and palliative care?

Palliative care is given at any stage of a serious illness, alongside curative treatment, with no prognosis requirement. Hospice care is for a terminal prognosis of six months or less, after the patient chooses comfort over curative treatment. Hospice is a type of palliative care, and Medicare pays for it through the Part A Hospice Benefit rather than visit by visit under Part B.

Is palliative care the same as hospice?

No. Palliative care is the broad category of comfort-focused care for anyone with a serious illness, and it continues alongside treatment. Hospice is the branch of palliative care for the last months of life, once curative treatment stops and a physician certifies a prognosis of six months or less.

Does Medicare cover palliative care?

Yes. Medicare Part B covers palliative care visits as ordinary medical care. In 2026 the patient pays the $283 Part B deductible and then 20% coinsurance for each visit, unless a secondary plan covers it. Medicare also pays for advance care planning conversations, and waives cost sharing when they happen during the Annual Wellness Visit.

Who pays for hospice care at home?

For most people, the Medicare Hospice Benefit under Part A pays for nearly all home hospice care tied to the terminal illness. The patient pays at most $5 per prescription for symptom control and 5% of the approved amount for inpatient respite. Medicaid, the VA, and most private insurers offer similar benefits. Care must come from a Medicare-certified hospice.

Can you be on palliative care and hospice at the same time?

An adult on Medicare who elects hospice receives palliative care from the hospice team, so a separate palliative program usually steps back. The patient cannot receive curative treatment for the terminal illness while enrolled. Children under 21 on Medicaid or CHIP can receive curative treatment and hospice together under concurrent care rules.

How long can a person stay in palliative care?

Palliative care has no time limit. A patient can receive palliative care for months or years, through treatment and recovery, for as long as the serious illness creates symptoms or decisions that need specialist support. Some patients leave palliative care when they recover; others move into hospice when treatment stops working.

Why would someone choose palliative care over hospice?

Someone chooses palliative care over hospice when they want to keep treatment aimed at the disease, such as chemotherapy, dialysis, or heart failure therapy, while getting help with symptoms and decisions. Palliative care also fits patients whose prognosis is longer than six months or uncertain, since it has no eligibility requirement tied to life expectancy.

What ICD-10 code is used for palliative care?

The ICD-10-CM code is Z51.5, Encounter for palliative care. Coders typically report the underlying serious illness first and add Z51.5 to show palliative care took place. Hospice claims are different: the principal diagnosis must be the terminal condition, and CMS returns claims that list debility or adult failure to thrive as the principal hospice diagnosis.

Can hospice teams use AI on patient records under HIPAA?

Yes, if the AI vendor signs a Business Associate Agreement and handles PHI under HIPAA safeguards. Hathr.AI includes a signed BAA on every web app account at signup, runs on FedRAMP High infrastructure in AWS GovCloud, and never trains models on customer data. It costs $47 per user per month for unlimited use, with a 7-day free trial and no seat minimums.

The bottom line

Palliative care and hospice share a philosophy and serve different moments. Palliative care supports anyone with a serious illness, at any stage, alongside treatment, and Medicare pays for it visit by visit. Hospice surrounds a person and their family with comfort-focused care in the final months, most often at home, paid almost entirely by the Medicare Hospice Benefit. The definition was never the hard part. Timing is, and the national data shows most families decide late. Watch the trajectory, not the calendar, and start the conversation while it can still help.

If you run a hospice or palliative program, the same principle applies to your documentation: the evidence that supports the right care at the right time is already in the chart. Hathr.AI helps your team find it, cite it, and put it in the note.

Sources

• Centers for Medicare & Medicaid Services, FY 2027 Hospice Wage Index, Payment Rate Update, and Quality Reporting Program Final Rule (CMS-1851-F), July 30, 2026
• Medicare Payment Advisory Commission, Report to the Congress, Chapter 10: Hospice Services, March 2026 (2024 data)
• 42 CFR Part 418, Hospice Care, sections 418.3, 418.22, 418.24, and 418.54, via eCFR
• Medicare, Hospice care coverage
• Temel JS et al., Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer, New England Journal of Medicine, 2010
• CMS, 2026 Medicare Parts A and B Premiums and Deductibles fact sheet, November 2025
• Center to Advance Palliative Care, GetPalliativeCare.org provider directory