Does Medicare Cover Respite Care?
Medicare covers qualified respite care for beneficiaries, typically with a 5% coinsurance charge. Learn how Medicare Supplement Insurance can pay for respite care Medicare and other out-of-pocket costs.
Medicare covers respite care for up to five days at a time, typically with a 5% coinsurance cost. A Medicare Supplement insurance plan can pay for your Medicare respite care coinsurance and other Medicare costs, such as deductibles and copays.
Respite care is temporary care provided in a nursing home, hospice inpatient facility or hospital so that a family member or friend serving as the patient’s caregiver can rest or take some time off from their duties.
In other words, when a full-time caregiver needs to step away, respite care is used to fill the gap until the caregiver returns.
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When Does Medicare Pay for Respite Care?
Medicare Part A covers respite care for up to five days at a time when used as part of a beneficiaries’ hospice care benefits.
The patient must first meet Medicare eligibility criteria for hospice care, which includes:
- Certification of terminal illness from a doctor
- Acceptance of palliative care in place of curative care
- Signed statement declaring the choice of hospice care rather than other Medicare-covered treatment
Medicare Part A will only cover respite care when the hospice care is being administered in a Medicare-approved inpatient hospice facility. Medicare Part A will not cover respite care when hospice care is being provided at home.
You can find a Medicare-approved hospice care facility using the Medicare.gov care compare tool to see star ratings and other quality measures of different facilities.
You will typically be responsible for a coinsurance payment equal to 5% of the Medicare-approved amount for respite care under Medicare Part A.
Medicare Part B does not cover respite care. Part B provides coverage of outpatient care such as doctor’s appointments and therapy along with durable medical equipment and supplies.
Do Medicare Supplement Plans Help Pay for Respite Care?
A Medicare Supplement Insurance (Medigap) plan can pay for some or all of the cost of the 5% coinsurance payment for respite care required by Medicare Part A.
Use the chart below to compare each type of Medicare Supplement plan.
What Is an Example of a Time You Need a Respite?
A caregiver may need a respite due to:
- The need for a break from the stress and demands of caregiving
Respite care helps prevent caregiver burnout and allows caregivers an opportunity to refresh and recharge and continue to give their best to their loved one.
What Are the Disadvantages of Respite Care?
While respite care certainly brings its benefits to a caregiver, the practice doesn’t come without its drawbacks.
Respite care costs money, and the person administering the care may not be familiar with the preferences and routines established by the caregiver and their loved one.
The person receiving care may have a hard time adjusting to a new face, even for just a day or two. Particularly when a person is accustomed to a close friend or family member taking care of them, the thought of a stranger interrupting the routine can be unsettling.
It’s not only the patient who might have some negative feelings about respite care. Caregivers may feel a sense of guilt when leaving their loved one’s side for a period of respite care.
Does Medicaid Pay for Respite Care?
Medicaid coverage varies by state, but many state Medicaid programs do offer coverage for respite care under the program’s Home and Community-Based Care Services (HCBS) waiver program.
Learn more about Medicare Supplement insurance and compare plans available where you live to find a plan that pays for respite care coinsurance costs.
Compare Medigap plans in your area.Find a plan
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