Many people in Chicago, Illinois, shy away from hospice care due to concerns about the associated costs. But the truth is, the majority of those who qualify pay little to nothing for the services they need.
The reason for this is that most individuals who are eligible for hospice are also eligible for Medicare – and Medicare Part A covers nearly everything. Below, we answer some of the questions we frequently receive about hospice coverage and Medicare.
Who Qualifies for the Medicare Hospice Benefit?
Anyone in Chicago who has Medicare Part A can arrange for hospice care if they meet the following criteria:
- They are terminally ill, as certified by their own physician (if they have one) and by a hospice medical director or doctor
- They are expected to live for six months or less, assuming their illness follows the usual course of progression
- They are choosing palliative care – meaning comfort care – rather than continuing to undergo curative treatment
Before services begin, patients must sign a statement indicating their choice of hospice over other Medicare-covered treatments. However, the decision isn’t set in stone – everyone who chooses hospice care can change their mind at any point.
What Hospice Services Does Medicare Cover?
Almost everything that a terminally ill individual needs to live comfortably is covered by the Medicare hospice benefit. This includes:
- Medication to control pain and unpleasant symptoms
- Medical equipment, like a hospital bed or wheelchair
- Medical supplies, such as bandages and Foley catheters
- Intermittent physician and skilled nursing services
- Physical, occupational and speech therapy services
- Massage, music and other complementary therapies
- Mental health counseling for the patient and their family
- Grief support and bereavement care for loved ones
- Short-term in-patient care and around-the-clock care
- Respite care to provide family caregivers with a break
While the Medicare hospice benefit is comprehensive, it does come with certain exceptions. Medicare beneficiaries may face out-of-pocket costs for:
- Room and board at a local facility, unless for in-patient or respite care
- Medical care or treatments that aren’t prescribed for patient comfort
- Therapies and support for issues unrelated to the terminal illness
In addition, Medicare doesn’t typically cover ambulance transportation, urgent care or any other services that haven’t been arranged by the hospice care team. However, with a real emergency situation – such as a severe burn or broken bone – this may not be the case. If there’s any question, though, patients or their loved ones should contact the hospice team.
Where Can Patients Receive Hospice Services?
The Medicare hospice benefit allows for services to be provided at a number of different locations. Terminally ill individuals can receive care at:
- Their own private home
- The home of a relative or friend
- A local nursing home
- A residential care center
- A skilled nursing facility
- A Chicago-area hospital
- An independent hospice house
In hospice care, the comfort of the terminally ill individual is of paramount importance. As such, services are most often provided wherever a patient is currently living, as that’s where they feel most at ease.
How Long Does Medicare Cover Hospice Care?
As we mentioned above, an individual must have both a terminal diagnosis and an expected prognosis of six months or less to qualify for hospice services under the Medicare benefit. However, this doesn’t mean care is capped at six months.
Medicare covers hospice services for the duration a patient remains eligible, and coverage is provided in benefit periods:
- Two 90-day benefit periods
- Any number of 60-day benefit periods
Initially, a patient is covered for two 90-day stays in hospice, and following that, Medicare covers as many 60-day periods as the individual requires. Near the end of each time interval, the attending physician reassesses the situation, coming to one of two decisions:
- If the patient is still considered to be terminally ill, with a limited life expectancy, services continue without interruption.
- If the patient’s condition has improved and they no longer have a prognosis of six months or less, they’ll be discharged from hospice.
In the event a patient is discharged, they can always return. As long as they meet Medicare’s criteria for hospice care, services can be arranged.
Do Medicare Advantage Plans Handle Hospice Differently?
Some Chicago residents have Medicare Advantage (MA) plans, or private insurance plans that offer Medicare-covered benefits. These plans may have coverage for:
- Additional medically necessary services, such as vision and dental care
- Treatments for medical concerns that are unrelated to the terminal illness
- Prescriptions for other health issues, if a plan includes drug coverage
Coverage under a dual-eligible special needs plan (D-SNP), a type of MA plan for individuals enrolled in both Medicare and the Illinois Medicaid program, is also a bit different. With these plans, some costs not paid for by Medicare Part A, such as room and board at a nursing home, may be covered.
In any case, anyone with a Medicare Advantage plan who is ready for hospice care should begin by contacting the plan. As per the guidelines, the MA plan must help in locating a Medicare-approved hospice agency.
Do you have other questions about Medicare and hospice coverage? Or would you like information on alternative ways to pay for hospice care in Chicago, Illinois? Either way, the friendly professionals at Suncrest are always happy to help – contact us today!
