VA Hospice and Palliative Care at Home: A Family Guide

These are the easy-to-miss angles — the early-eligibility rules and quiet ways veteran families leave help on the table. Each one is explained in full below.

Families often hear these two words together and assume they mean the same thing. They do not, and the difference matters a great deal for when you ask for help.

VA describes palliative care as the broader of the two. Its Palliative and Hospice Care fact sheet states that palliative care "is a broader term that includes hospice care but does not require the presence of an imminently terminal condition (prognosis of 6 months or less)" and "may include a balance of comfort measures and life-prolonging interventions." VA's palliative care page says the same thing in plainer words: "Palliative Care can be combined with treatment that is aimed at curing or controlling your illness. It can be started at the time of your diagnosis and may be provided throughout the course of the illness."

In plain terms: your loved one can be actively treating an illness and still have a palliative care team helping with pain, breathing, nausea, anxiety, family stress, and decisions.

Hospice sits inside that same continuum, at the end of it. VA's national policy defines hospice as care for someone with a prognosis of six months or less if the disease runs its normal course, as determined by a VA physician, where the veteran or a surrogate makes an informed decision to receive it and the focus is comfort and quality of life.

Both can be delivered where your loved one already lives. VA's fact sheet lists home, community, outpatient, VA Community Living Centers, and inpatient settings as places palliative and hospice care are provided.

VA's Geriatrics and Extended Care hospice page is direct about this. It states: "There are NO COPAYS for Hospice Care, whether it is provided by the VA or an organization with a VA contract." That page does not publish an effective date, so treat it as VA's current published position rather than a dated rate — and confirm it with VA before you plan around it.

The copayment regulation points the same way. 38 CFR 17.108(e) lists services that are not subject to copayment requirements for inpatient hospital care, outpatient medical care, or urgent care, and item (15) on that list is simply "Hospice care."

Palliative care is treated differently. Hospice care and palliative care are both part of VA's medical benefits package under 38 CFR 17.38(a)(1)(xi)(A), but VA's palliative care page states plainly that "Copays may be charged for Palliative Care."

VA's published copay rates, effective January 1, 2026, show $15 for a primary care outpatient visit and $50 for a specialty care outpatient visit for veterans who owe copays at all. Many veterans owe nothing. VA's rate page notes that veterans with a service-connected disability rating of 10% or higher do not pay outpatient or inpatient copays, and that veterans in Priority Group 1 do not pay medication copays. For veterans in priority groups 2 through 8 who do owe medication copays, VA caps those at $700 per calendar year under the same January 1, 2026 rates.

Copay rules and dollar amounts change, and VA updates them separately from its December 1 benefit-rate changes. Confirm the current amounts with VA before you plan around them, and ask specifically whether your loved one's priority group owes any copay at all.

VA states that all enrolled veterans are eligible for hospice care if they meet the clinical need for the service. Enrollment in VA health care is the gateway; the clinical judgment comes from a VA physician.

VA's Palliative and Hospice Care fact sheet says hospice care in all settings is a benefit for all enrolled veterans as part of the VA medical benefits package, and lists three criteria. Read the second one carefully — it is more flexible than most families expect.

Notice the tension between the second and third criteria. VA's own wording says the comfort-focused goal "does not exclude disease modifying treatments," while also saying the veteran makes an informed decision to forego curative treatment for the terminal condition. Meanwhile VA's public hospice page describes hospice as being for veterans who are "no longer seeking treatment other than palliative care." This is worth a direct question to the VA team: which specific treatments can continue, and which stop? Do not assume. Ask, and ask them to write the answer in the care plan.

Nothing here is a promise. Eligibility is decided by VA, not by a website, and this guide is not affiliated with or endorsed by the Department of Veterans Affairs. Use "we may qualify" language when you call, and let the VA team make the determination.

This is the question families ask once the word "hospice" stops frightening them. The answer is more concrete than most people expect.

VA states that hospice care, including VA-purchased community hospice care, covers hospice diagnosis-related visits by interdisciplinary staff, medications, supplies, durable medical equipment, and ancillary services as outlined in the plan of care. That means the hospital bed, the oxygen, the comfort medications, and the nurse who comes to the house are part of the benefit, not separate purchases.

On the palliative side, VHA Directive 1139 requires that each VA medical facility have a fully functioning Palliative Care Consult Team with enough dedicated staff to meet the needs of veterans with serious illness and their families. VA describes that team as an interdisciplinary group from medicine, nursing, social work, mental health, and chaplaincy, which may also include clinical pharmacists, dietitians, and physical, occupational, creative art, recreational, and music therapists, plus community health nurse coordinators.

VA also requires that access to primary (basic) palliative and hospice services be available 24 hours a day, 7 days a week at VA medical facilities that offer inpatient services. If you are with a community hospice agency instead, ask that agency directly what its after-hours and weekend coverage looks like — that is the number you will need at 2 a.m.

Many older veterans have both VA health care and Medicare. This creates a real choice, and one of the most valuable facts in this whole guide.

VA states that it must offer to purchase or provide palliative and hospice care for veterans determined to need it, and that if an enrolled veteran chooses VA to be the payer, VA is responsible for purchasing or providing hospice services. VA's fact sheet adds that this choice of payer "applies even if the Veteran is eligible for hospice under Medicare or Medicaid." VHA Directive 1139 also notes veterans may choose to receive this care through a non-VA payment source such as Medicare.

The Medicare hospice benefit works differently on cost and on treatment. Under 42 CFR 418.400, a Medicare hospice patient may owe coinsurance of about 5 percent of the cost of each palliative drug or biological prescription, and that per-prescription coinsurance "may not exceed $5." There is also coinsurance equal to 5 percent of Medicare's payment for each respite care day, and the regulation caps the individual's respite care coinsurance during a hospice coinsurance period at the inpatient hospital deductible for the year the period began. Confirm the current respite cap amount with Medicare, since the inpatient hospital deductible changes every year.

Electing Medicare hospice also means waiving Medicare payment for services related to treating the terminal condition or a related condition, other than through the chosen hospice, another hospice under arrangement with it, or the attending physician. Medicare hospice runs in an initial 90-day period, a second 90-day period, then an unlimited number of 60-day periods, and it can be revoked at any time during an election period and re-elected later.

Here is the part VA went out of its way to correct in writing. VHA Directive 1139 was reissued on September 9, 2022 specifically to address "the myth that terminally ill Veterans electing the Medicare Hospice Benefit are no longer eligible to access their VHA benefits." VA policy states that enrolled veterans have full access to their VA medical benefits whether they are receiving hospice care or not, and that VA will offer to provide or purchase specialized "concurrent palliative care" on top of a community hospice plan when a VA team identifies the need — as long as it does not duplicate what the hospice is already providing.

There is no single form to fill out. VA policy defines a palliative care consult as a request to the VA medical facility Palliative Care Consult Team by physicians, other health care providers, or care teams — which means your job is to ask a VA provider or the care team to place the consult.

VA's own guidance for both services is simple and human: talk with your VA social worker, or for palliative care, talk with your primary care provider. Social workers at VA medical centers are the people who know which local agencies have VA contracts and how to move a request forward.

You do not have to wait for the doctor to raise it. VA policy says palliative care consults may include assessments and recommendations related to prognosis, pain and symptom management, goals of care and associated treatment decisions, advance care planning, psychosocial and spiritual concerns, family meetings, and referrals to hospice and other VA and community services. Any one of those is reason enough to ask.

If the veteran is not yet enrolled in VA health care, that comes first. Enrollment uses VA Form 10-10EZ and can be done online at va.gov. You never have to pay for help with this — accredited VSO representatives, County Veterans Service Officers, and state veterans agencies all assist free of charge.

Bereavement support is written into the benefit, not added on as a courtesy. VA policy defines hospice as including bereavement support for families, and its fact sheet notes that community hospices provide bereavement support for the family. Under the Medicare hospice rules that govern most community agencies, the hospice must make bereavement services available to the family and other individuals in the bereavement plan of care for up to one year following the death.

Very few families use that year. It is already paid for. Ask the hospice agency, before the death if you can, exactly what their bereavement program includes and who will call you.

VA offers additional bereavement help, though the eligibility rules are specific and worth checking rather than assuming. VA's Vet Center materials describe bereavement counseling for the surviving spouse, child, or parent of a service member who died while serving. The Vet Center eligibility page also lists bereavement services for families of reservists and National Guard members who die while on duty, for family members of a veteran who was receiving Vet Center services at the time of death in defined circumstances, and for families of veterans and service members who die by suicide. Contact the Vet Center Call Center at 877-927-8387 or vetcenter.bereavement@va.gov to ask whether your family qualifies — do not assume either way.

For caregivers, the VA Caregiver Support Line is 1-855-260-3274, Monday through Friday, 8 a.m. to 8 p.m. ET, and every VA facility has Caregiver Support Program staff. VA also offers chaplain services to religious and non-religious families alike. VA lists two grief-specific supports for family caregivers enrolled in the Program of Comprehensive Assistance for Family Caregivers: REACH VA Bereavement, a four-session program with a coach, and the Annie text message program. Ask your Caregiver Support Program team about both. If anyone in the family is in crisis, the Veterans Crisis Line is 988, then press 1 (text 838255, TTY 1-800-799-4889).

In many families — and this is especially common in immigrant households — talking openly about death feels like inviting it, or like giving up on someone you love. Adult children are sometimes told directly by elders not to say the word. That instinct deserves respect, not correction.

VA's own policy language leaves room for this. VHA Directive 1139 states that the goal of palliative and hospice care is relief of suffering, control of symptoms, and restoration of functional capacity "while remaining sensitive to personal, cultural and religious values, beliefs and practices," and that VA medical facilities are required to identify veterans who may be appropriate for this care and determine their specific preferences for care.

A practical way in: do not open with hospice. Open with comfort. "Dad is in pain and not sleeping. There is a VA team whose whole job is making him comfortable, and it does not mean stopping his treatment." That is an accurate description of palliative care, and it is usually a door people will walk through.

It also helps to name who decides. VA policy says the veteran, or a surrogate if the veteran cannot decide, makes the informed decision about hospice — not the wider family, not the doctor. Saying that out loud often lowers the temperature, because nobody feels they are being asked to give up on their father or husband.

Ask for a chaplain if faith is part of your family's life. VA describes its chaplains as supporting both religious and non-religious people and as members of the patient care team. And ask for an interpreter every time — precision matters most in exactly the conversations that are hardest to have.

Accredited Veterans Service Organization representatives help with VA claims free of charge. VA states that the services an accredited VSO representative provides on your VA benefit claims are always free, while an accredited attorney or claims agent can charge fees for their services. County Veterans Service Officers, which many California counties operate, also provide help at no cost and know the local landscape; CalVet recommends working with the CVSO nearest you.

VA warns plainly about people who charge for this. Its fraud page describes "claims predators" as bad actors who try to unlawfully charge veterans a fee to help process claims with VA, often promising faster processing or higher ratings in exchange for high fees, and urges veterans to use only VA-accredited attorneys, claims agents, and VSO representatives when filing for benefits. You should not pay anyone to file an initial claim for benefits.

If someone pressures you for a fee, promises a faster decision, or asks for a cut of a retroactive payment, report it at VSAFE.gov or call the VSAFE Fraud Hotline at 1-833-38V-SAFE (833-388-7233).

One more free resource worth knowing: We Honor Veterans is a program created by VA together with the National Hospice and Palliative Care Organization (now the National Alliance for Care at Home) to help community hospice agencies provide veteran-centered end-of-life care. VA reports that more than 80 percent of community hospice agencies nationwide have made a commitment through it. When you are choosing an agency, it is a fair question to ask whether they participate.

This guide is an independent educational resource. It is not affiliated with, authorized by, or endorsed by the Department of Veterans Affairs, and nothing here decides eligibility. Only VA can do that.