Medicare coverage of trilogy in hospice

does anyone know if Medicare will still pay for bipap machines like the Trilogy when you go into hospice. They say they only cover comfort stuff, well feeling like you can get enough air is comfort.

Essentially hospice replaces medicare. It is up to the hospice what they cover. You may have to shop around. I have heard of some covering vents if you are already vented all the way to not accepting feeding tubes. You will have to check and see. Btw some hospices are for profit. My preference would be a not for profit but the important thing is that thry cover what you need

Good to see you posting Neil. I can't answer it but have wondered a lot lately how you are doing. So how are you doing?

If you already have a Trilogy, as I'm pretty sure you do, it will still be reimbursed by Medicare (traditional Medicare, not MA plans, pays for hospice so if you are on an MA plan, it will continue to rent the Trilogy and supplies because those are not intrinsic to hospice), but not all hospices are created equal in terms of how well they support it staff-wise.

If you are shopping hospices, Neil, make sure they know you are using it "non-invasively" since they are much more likely to want to deal than if you have a trache. Personally, I would call it BiPAP because they are more familiar with that modality and essentially as NIV that is what it is.

I stand corrected Laurie but am confused. If you are renting the equipment and medicare was paying part then when hospice takes over medicare continues to pay the other part ? It does not revert to hospice to pay? Then why was that one of the issues with the whole eyegaze fiasco?

When I singed up for hospice care through Bayada, I had already been using the Trilogy. They asked me in a subtle way if I would give up the Trilogy for a regular bi-pap.

I told them I was not willing to give up the Trilogy, and if it came to that I would probably not sign on with them. They did assure me I could keep the trilogy if I wished.

MY trilogy is still being serviced by the medical supply company from which it was rented, and the downloads from it are being read by the doctors from the ALS clinic that I used to attend, along with any prescription changes for settings.

As far as I know, Bayada is covering the cost through their payment from Medicare Hospice. (you can look up how much they are getting at Mymedicare.gov and signing in to your account) All I know for sure is that I am not being billed for anything.

neil im going through the same. my dr's says i need one bad. my team said they was going to get me one but that didn't happen. now their telling me hospice will take care of it but that can take up 6 m's to a year. i might not need it by then lol.

my son got me one off of ebay bit everything didn't come with it, so i took it in with me to my dr to what it needs. they told me it's to old and i needs one that dose both ok.

When my Lonny went on Hospice they let us keep the trilogy and cough assist with our current provider. they looked into replacing the trilogy with a bipap, but the setting are different of course and there is not a battery backup so opted to keep the trilogy. the provider that they use didn't offer the trilogy or the cough assist which is why we had ours thru the original provider. they just contracted with hospice to provide to us. Neil, don't worry, it is not like the day you sign up they take your equipment away--we signed up and nothing changed; it took about a week and a half for them to finally decide what equipment would work for us.

Nikki,
The "two payors" is only the case for those w/ Medicare Advantage plans. By rule, Medicare Advantage doesn't pay for hospice-related expenses. So if someone already has a Trilogy, a wheelchair, whatever, that was purchased/leased by a MA plan, its care and feeding will continue to come out of the MA plan while in hospice. These items may be rolled up on the Medicare portal since Medicare is still payingin the end. There should never be an issue about continued reimbursement for DME in hospice. The issue that arises is new leases/purchases.

SGD is a whole 'nother regulation, and comes under traditional Medicare rule. Remember that MA plans have to enforce traditional Medicare rules --they can pay for more than traditional Medicare, but they can't pay for something that Medicare expressly forbids or restricts.

Davbo, if you're in hospice, you can "leave" and return if that expedites the Trilogy. But that is just paperwork the hospice/your clinic should handle. Do you have a BiPAP of any kind currently? What did the Trilogy off eBay not have? Six months is not acceptable and makes no sense to me.

lgelb said:

Nikki,
The "two payors" is only the case for those w/ Medicare Advantage plans. By rule, Medicare Advantage doesn't pay for hospice-related expenses. So if someone already has a Trilogy, a wheelchair, whatever, that was purchased/leased by a MA plan, its care and feeding will continue to come out of the MA plan while in hospice. These items may be rolled up on the Medicare portal since Medicare is still payingin the end. There should never be an issue about continued reimbursement for DME in hospice. The issue that arises is new leases/purchases.

SGD is a whole 'nother regulation, and comes under traditional Medicare rule. Remember that MA plans have to enforce traditional Medicare rules --they can pay for more than traditional Medicare, but they can't pay for something that Medicare expressly forbids or restricts.

Davbo, if you're in hospice, you can "leave" and return if that expedites the Trilogy. But that is just paperwork the hospice/your clinic should handle. Do you have a BiPAP of any kind currently? What did the Trilogy off eBay not have? Six months is not acceptable and makes no sense to me.

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the one i got is not a trilogy that they said i need. when i say 6 to a year . that's the way it's been going for me. everything they done . they we are right on it. then it goes in to that long. it has been hard for me to breathe and sleeping is not good. when i do get to sleep in right back up from and can't catch my breathe

My mom had both her trilogy and cough assist prior to transitioning to hospice. Vitas, our hospice company, kept both machines in place and contracted with the Respiratory company that issued them. My mom was paying $440 per month rental after Medicare paid their portion. Under hospice she will not pay anything out of pocket. I hope you find the right provider in your area.

We just entered hospice and did a lot of shopping around. There are 62 different hospice providers in our area, which is a lot. So we interviewed 5 of them. One said that the trilogy or Astral was aggressive therapy and would not cover it. We said thanks and moved on. Ended up getting three of them to agree to provide a trilogy or Astral, and 2 of them agreed to write a one time contract with a company that specializes in ventilation in the state and has great experience with ALS patents. We went with one of the two. Bottom line is that you need to shop around and don't be afraid to negotiate with them. Our going in position, was that not providing a trilogy or Astral was a deal buster. We made sure we pushed the position that there is no cure for ALS and that the use of a non-invasive ventilator, that has the appropriate functions that these two units have, is comfort not aggressive therapy. Hospice is a business and you are the customer, negotiate going in and remember you can switch providers any time you want.

Davbo, if you want to adjust your settings, PM me what your machine is, what your current settings are and what's wrong with them (too much / too little air to breathe in/against, breaths too long/short, deep/shallow, etc.)

DJ & Familial make good points to shop hospices, though there is not as much choice in all markets. So if you are in an area where there are no good hospice choices, as you see them, just a reminder that any good home health agency/nurse (for which your doc can write an order) can provide "palliative care" for the end of life. Of course, home health copays, if any, would apply, instead of hospice benefits.

For anyone for whom a Trilogy or Astral is a steep rental or difficult to get for some reason, I just want to point out that we had neither. The clinics push the Trilogy, but they're not paying. The only substantive difference between a "volume-controlled" BiPAP (any machine with iVAPS or AVAPS, currently available used on Secondwind at $675) and the Trilogy/Astral machines is the internal battery. If someone is still going out, that is relevant. If they're not [much], it's not.

We used a battery-operated CPAP (currently selling for $575 new) w/ exhalation relief for our relatively rare outings, and various used BiPAPs for home. So we had no rental payments, and our various purchases more than paid for themselves by that criterion.