Life can be quite challenging with a terminal diagnosis, and coping can be especially difficult when a loved one is affected. In Salt Lake City, Utah, hospice care brings support, comfort and peace of mind to those who are faced with this situation, but many people believe that services are beyond their financial reach. This is rarely the case.
Medicare offers a great deal of assistance to the terminally ill and their families, and thanks to the Medicare hospice benefit, most pay little to nothing for the services they need. Understanding the available coverage can help ease the end-of-life experience. As such, if someone you hold dear has been diagnosed with a terminal illness, learning the facts about hospice care and Medicare is advisable. Here, the knowledgeable professionals at Suncrest Hospice of Salt Lake City explain what you need to know.
Eligibility Criteria for Hospice Care
Before going into how long Medicare pays for hospice care, we need to cover the requirements. An individual must meet certain criteria for services to begin:
- They must have a terminal illness, as certified by their own doctor and confirmed by a hospice medical director or physician.
- They must be expected to live for no longer than six months, based on their illness and its usual course of progression.
- They must choose to receive comfort-focused care rather than continuing to pursue further curative treatment.
To take advantage of the Medicare hospice benefit, patients must also be enrolled in Medicare Part A. And for services to be covered, they must be provided by a Medicare-approved hospice care agency, like Suncrest.
Duration of Medicare Hospice Coverage
One of the eligibility requirements for Medicare hospice coverage is an expected prognosis of six months or less, but this doesn’t mean patients are only able to receive services for six months.
With any terminal illness, doctors often find it difficult to accurately predict the amount of time before death. Every individual is unique, and diseases can follow many different paths of progression. Occasionally, hospice patients survive longer than expected, outliving their initial prognosis.
Fortunately, Medicare pays for hospice care for as long as an individual is eligible. Services are covered in benefit periods – two 90-day periods followed by any number of 60-day periods. The attending physician reassesses the patient at the end of each interval, and if their condition hasn’t improved, and they’re still expected to pass away within six months, care continues without interruption. If this isn’t the situation, Medicare coverage for hospice ends. But if the patient once again meets the eligibility requirements, services can resume.
Hospice Services Covered by Medicare
Now we’ve discussed how long Medicare pays for hospice care, but we really haven’t explained what that means. How does hospice offer support, comfort and peace of mind to those dealing with a terminal diagnosis?
The answer is different for everyone. Medicare-approved hospice care agencies are required to establish a personalized plan of care (POC) for each patient, outlining the specific services needed for them to remain at their own home – or wherever they currently live – toward the end of life. Doctors, nurses, therapists, social workers and counselors work with the terminally ill individual and their loved ones to develop the care plan. Medicare covers a range of hospice services, including the following:
- Medication and therapies for pain control and symptom management
- Any durable medical equipment and medical supplies the patient needs
- Intermittent assistance with housekeeping and personal care tasks
- Regular visits from nurses, therapists and other skilled professionals
- Short-term continuous home care to address urgent medical concerns
- In-patient care when symptoms are unmanageable in the home setting
- Professional support to help those struggling with the inevitability of death
- Bereavement care and grief counseling services for surviving loved ones
Medicare pays for the hospice care services included in the POC, and the document can always be amended to address new issues. In fact, the document is reassessed at least every 15 days to ensure that everyone has the necessary support.
Limitations to the Medicare Hospice Benefit
Under Medicare, numerous hospice services are available at no cost to Salt Lake City patients. Depending on an individual’s needs, they may receive physician and skilled nursing care, physical therapy, speech-language pathology services and assistance from social workers, chaplains, bereavement specialists and trained volunteers.
But while the Medicare hospice benefit is comprehensive, patients and families need to be aware of the limitations. Medicare doesn’t pay for the following:
- Potentially curative procedures and treatments
- Medical interventions for ailments unrelated to the terminal diagnosis
- Services not provided by or arranged for by the hospice care team
In addition, coverage for room and board at a Salt Lake City hospital or skilled nursing facility is only provided when medically necessary or when family members request respite care. And while the staff at some hospice care agencies may offer guidance on legal documents, such as advance directives or living wills, estate planning isn’t covered under the Medicare hospice benefit.
Ensuring End-Of-Life Comfort for a Loved One
At Suncrest Hospice of Salt Lake City, we strive to help patients and families make informed decisions about end-of-life care options. Our compassionate team understands the challenges in coping with a terminal illness, and we believe everyone deserves to have the right support. For more information on Medicare and paying for hospice care in Salt Lake City, Utah, contact us today.
