A Planning Guide for Palliative and Hospice Care

When a loved one’s health begins to decline, decisions come quickly. These are the moments when emotional decisions collide with financial realities. And while no amount of planning can remove the weight of the situation, the right preparation can ease it for your loved ones and everyone supporting them. In this guide, we’ll walk through the care options available, the financial considerations that come with each, and how thoughtful planning can provide clarity and comfort when it matters most.

Understanding the difference: Palliative vs. Hospice care

What kind of care is right for this stage? Palliative and hospice care both prioritize comfort and quality of life, but they serve different purposes, timelines and goals. Knowing the difference can help you make more informed, compassionate decisions.

Palliative care: Support at any stage of illness

Palliative care focuses on alleviating pain, managing symptoms and improving quality of life, even while curative treatments continue. It’s appropriate at any stage of a serious illness and often acts as a layer of support for both the individual and their family.  Palliative care doctors can be a patient advocate as complex medical decisions need to be made, and care team doctors may not agree. For example, a parent undergoing aggressive cancer treatment might also receive palliative care to help manage fatigue, pain or emotional distress. The goal isn’t to replace treatment, but to help them feel more like themselves during it and to ensure they understand complex options they may be offered to them. Typically, palliative care is coordinated by a team — physicians, nurses, social workers and chaplains — who work alongside existing providers. It can be provided inside hospitals, outpatient clinics or even at home, depending on your needs and insurance coverage.

Hospice care: Comfort in the final chapter

Hospice is a specific type of palliative care offered when curative treatments are no longer being pursued, typically when a doctor believes the individual has six months or less to live but this could be a longer timeline. For example, an individual with advanced heart failure may decide to stop hospital-based treatments and focus instead on comfort. At this point, hospice care can provide symptom relief, emotional support and family guidance.

When hospice begins, the focus shifts entirely to quality of life: easing discomfort, supporting the family and ensuring care aligns with the person’s values and wishes. Hospice teams are available around the clock and provide in-home services like symptom management, grief counseling, caregiver support and respite care.  It is important to understand that many curative treatments like cholesterol medication, blood thinners, and similar curative drugs and devices would no longer be covered.

Questions to consider when choosing a type of care

• Is our loved one still pursuing curative treatment, or is the focus shifting to comfort?
• What symptoms or stressors need to be managed right now?
• Has a doctor discussed a prognosis or care plan for the next six months?
• Would in-home care be a good fit for our family’s needs and capacity?
• What level of emotional and logistical support do we need as a family?
• How does Medicare or private insurance coverage apply in our situation?
• Are we prepared for care to transition from palliative to hospice if needed?

Once your family has a sense of which type of care is appropriate, the next step is finding a provider that aligns with your needs, values and expectations. The right fit can make all the difference.

Begin by speaking with your loved one’s current medical team. A primary care physician, oncologist or specialist can often recommend local palliative or hospice providers they’ve worked with and trust. Ask if they have care teams they regularly partner with. Continuity between providers can make transitions smoother. Consider what groups may have easy access to medical records for care coordination, for example they are part of the same medical system.

You can also explore national directories to find vetted providers in your area:

• GetPalliativeCare.org allows you to search by ZIP code for palliative care providers across care settings.
  
• Medicare’s Care Compare tool helps you review hospice agencies, including quality ratings, ownership status and service offerings.
  
• Local hospitals and health systems may offer in-house programs or have referral relationships with established providers.

What to ask along the way

Once you’ve identified a few potential providers, schedule introductory calls or in-person meetings. Beyond medical expertise, look for a team that communicates clearly, respects your preferences and makes your family feel supported. Here are some helpful questions to guide those conversations:

• What services are included? Ask for a full overview: symptom management, in-home visits, counseling, medical equipment, respite care, spiritual support and more. Understanding what’s included and what’s not, will help avoid surprises later.
• Where is care provided, and how often? Some providers specialize in home-based care, while others focus on hospitals or nursing homes. Ask how frequently the care team visits and whether 24/7 on-call support is available.
• What role does the family play? Great providers see the family as part of the care team. Ask how they’ll involve you in decisions, prepare you for caregiving and support your emotional needs as well.
• How is this paid for, and what’s covered by insurance? Clarify Medicare or private insurance coverage upfront. Ask about any services that require out-of-pocket payments, including aides, home equipment or extended respite care.
• What’s your process for after-hours questions or emergencies? Illness doesn’t keep business hours. Make sure there’s a plan for support outside of regular appointments.
• How do you support transitions? If you’re starting with palliative care, ask how they help families transition to hospice if and when that time comes. Consistency and planning ahead can make those moments less jarring.

Planning for the financial side of care

End-of-life care can quickly become expensive.

Palliative care often overlaps with ongoing treatment, which can make costs harder to predict and plan for. And even with full Medicare coverage, families may still face out-of-pocket costs for extended in-home support, non-covered medications or home modifications.

Knowing what to expect and planning ahead can reduce financial stress.

What’s typically covered

Palliative care may be partially covered through Medicare, Medicaid or private insurance. Coverage depends on how and where care is delivered. For example, hospital-based palliative care may be covered differently than in-home care. Because coverage isn’t standardized, families often need to confirm details directly with the provider and insurance carrier.

Most hospice care costs are covered by Medicare Part A for eligible individuals. Coverage generally includes

•   Visits from hospice nurses and doctor
• Pain management and symptom relief
•  In-home medical equipment and supplies (hospital beds, oxygen, etc.)
• Medications for comfort
•  Short-term inpatient stays (for symptom control or caregiver relief)
• Counseling and grief support for the family

If your loved one is a veteran, hospice and palliative services may be available through the VA Health System with benefits that can supplement or replace Medicare options.

That said, even with strong coverage, there are still important gaps to plan for.

Where out-of-pocket costs most often arise

Even with Medicare or private insurance, families may encounter expenses that aren’t fully covered, especially when care extends beyond clinical treatment into day-to-day support.

Here are some common areas where out-of-pocket costs can arise across both palliative and hospice care:

• In-home support beyond medical visits. While hospice covers regular check-ins from nurses and aides, it does not provide 24/7 in-home care. Families often hire private caregivers to assist with bathing, meals or round-the-clock supervision, services that typically fall outside of insurance coverage. Similarly, palliative care delivered at home may involve personal care needs not included in a standard plan.
• Respite care limits. Hospice benefits through Medicare include short-term respite care to give family caregivers a break, up to five consecutive days at a time. Anything beyond that may require out-of-pocket payment or coordination with private services. Palliative care may not include respite benefits at all.
• Home modifications and supplies. Preparing a home for end-of-life care often requires physical changes, including hospital beds, wheelchair ramps, safety rails and other accessibility upgrades. While some durable medical equipment is covered under hospice, broader home modifications usually are not. Supplies like extra linens, personal hygiene items or mobility aids may also fall outside standard coverage.
• Treatments unrelated to the primary diagnosis. Hospice coverage focuses on comfort rather than treatment. Medication or treatment for treatable conditions (e.g., high blood pressure, arthritis) likely won’t be covered once hospice begins.  If those medications or treatments are desired to be continued, they would need to be covered out of pocket. Palliative care plans often include a broader scope of support, but benefits can be limited based on the insurer’s definition of “medically necessary.”
• Emotional and family support services. While hospice includes counseling and bereavement support, the availability and depth of services can vary. Families seeking extended therapy, spiritual care or specialized support may need to pay privately. Palliative care may offer similar resources, but coverage often depends on the provider’s structure and what’s included in your plan.

Why planning ahead matters

End-of-life planning isn’t just about documents and dollars. It gives your family the clarity, confidence and space to focus on what matters most. These key actions can help you prepare emotionally, financially and logistically before a crisis makes decisions harder 

First, start the conversation early. Talk about care preferences, financial concerns and values well before they’re urgent. This might include family meetings or documenting personal wishes in writing.

Next, communicate clearly and compassionately. Be open about what’s possible, what’s needed and how decisions will be made. The more clarity upfront, the fewer misunderstandings later.

Then, plan for more than money. What will bring comfort and peace of mind to your loved one and your family?

Lastly, bring in the right professionals. Advisors, estate attorneys and social workers can help guide decisions and reduce the burden on family members during stressful time

The right advisor can help you tie these pieces together and support your family through every stage of care.

Working with a financial professional

End-of-life planning impacts every part of your financial life, from liquidity and tax exposure to legacy and family readiness. Here are key areas where proactive guidance can make a difference:

1. Clarify what you own and who’s affected
Start with a complete balance sheet. That includes insurance, business ownership, collectibles, digital assets and anything stored in a safe deposit box. Pair this with a family structure review to ensure planning reflects current relationships and responsibilities.

2. Make sure liquidity and cash flow are aligned
Immediate expenses, like caregiver support or funeral costs, often require fast access to funds. An advisor can help review liquidity strategies and adjust for a surviving spouse’s income needs, including evaluating whether investments should shift toward income generation.

3. Plan for tax-sensitive transitions
There are only a few windows to capture certain tax advantages, like capital loss carryforwards or a step-up in basis. A financial advisor can help coordinate timing and review how filing status, gifting or income may shift after death.

Additional areas a wealth advisor can support:

• Reviewing account titling, POD/TOD designations and beneficiary forms
•  Locating and updating life insurance policies
• Coordinating with estate attorneys, CPAs and care providers
• Involving spouses or adult children in appropriate planning discussions
• Proactively addressing personal property or sentimental assets to avoid family conflict

Start planning with confidence and support

Speak with your Comerica Wealth Advisor or reach out to connect with one to align your care preferences, liquidity needs and legacy goals.