Does Medicare Cover Respite Care?
- January 12, 2024
- Reviewed by John Krahnert
When a Medicare beneficiary receives Medicare-covered hospice care, Medicare covers respite care for their caregivers, up to certain limits.
Providing round-the-clock care is a full-time job, and there are times when a caregiver needs to step away from their duties. That’s when a type of substitute care called “respite care” is called upon.
Below we discuss what caregivers and their loved ones should know about respite care and how respite care is covered by Medicare.
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When Does Medicare Part A cover respite care?
Medicare Part A covers up to five days at a time of respite care when used while a Medicare beneficiary receives hospice care. Medicare Part A also covers inpatient stays at hospitals, skilled nursing facilities and certain other types of inpatient care.
In other words, if a person is in hospice care that is being covered by Medicare, Part A will cover up to five consecutive days of respite care should the person’s caregiver (or caregivers) need time away.
Medicare Part A will typically charge a coinsurance payment equal to 5% of the Medicare-approved amount for respite care when covered.
The respite care will only be covered if the hospice care is being administered in a Medicare-approved hospice facility and will not be covered if the hospice care is being done at home.
In order to be eligible for Medicare hospice care coverage, they must:
- Be diagnosed with a terminal illness and receive an accompanying certification
- Accept palliative care in place of curative care
- Provide a signed statement declaring their choice of hospice care instead of other Medicare-covered treatment
Does Medicare Advantage cover respite care?
Medicare Advantage (Part C) plans are required by law to cover everything that is covered by Original Medicare, which includes Medicare Part A and Part B. And because respite care is covered by Medicare Part A, it is required to be covered by all Medicare Advantage plans.
Some Medicare Advantage plans may have coverage levels or terms for respite care that are different than what is provided by Medicare Part A. And some Medicare Advantage plans may offer benefits that Original Medicare doesn’t cover.
Depending on the type of Medicare Advantage plan you have, you may need to use a network provider for respite care in order to maximize your benefits.
Does Medicare Supplement Insurance cover respite care?
Medicare Supplement Insurance, or Medigap, does not cover respite care itself. However, a Medicare Supplement plan can help supplement your Medicare Part A coverage of respite care.
Medicare Supplement Insurance provides coverage for deductibles, copayment, coinsurance and other out-of-pocket costs that are tied to Medicare Part A and Part B. When you use Medicare Part A for respite care coverage, a Medicare Supplement plan can boost those benefits.
There are 10 standardized Medicare Supplement plans that cover Medicare Part A coinsurance, including eight plans that cover it in full. That means these plans will cover the full cost of the 5% coinsurance charged by Medicare Part A for respite care.
Does Medicaid pay for respite care?
Many state Medicaid programs cover respite care under what’s called a Home and Community-Based Care Services (HCBS) waiver program. Unlike Medicare, Medicaid coverage is not federally standardized. Benefits can vary from one state to the next.
Contact your state Medicaid agency for more information about available respite care coverage.
What is an example of a time you need a respite?
Just as paid doctors and nurses may take time off from work for a vacation, to attend to another obligation or because of an injury or illness, personal caregivers may also need to temporarily step away from their duties for similar reasons.
Caregivers can also experience high levels of burnout and stress, and a respite may be necessary simply to reset and recharge.
What are the advantages and disadvantages of respite care?
The advantages of respite care include the opportunity for caregivers to take time off for illness, family emergencies or commitments or a much-needed vacation. And respite care offers a break from some of the stressful demands of caregiving and can help reduce caregiver burnout.
But are there any disadvantages of respite care?
Although Medicare Part A charges just 5% for respite care coinsurance, it’s still a payment that must be paid.
Plus, caregivers and their loved ones have a certain rapport, routine and way of doing things that a respite care provider may be unfamiliar with and the person receiving care may not be as comfortable with a stranger.
There can also be an element of guilt on behalf of the caregiver for leaving their loved one in the hands of someone else, even if only for a day.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
