Caregivers need time to themselves to continue providing the best assistance possible, but often feel it is cost prohibitive. “I need a break” becomes the caregiver’s theme song and the question frequently asked is whether Medicare will pay for the caregiver’s needed respite care. Medicare Part A will cover limited respite care stays when it’s part of the recipient’s hospice care.
Stress is detrimental to your health, and the toll taken on family caregivers is a health threat and a killer. Isolation causes caregivers to feel cut off from the world. Caregivers often neglect their own health care by missing or putting off doctor appointments until issues that could be caught early are allowed to become life-threatening health catastrophes. Learn how Medicare respite care benefits can help take the pressure off.
Does Medicare Cover Respite Care?
If the patient meets Medicare’s eligibility requirements for hospice, Original Medicare Part A will cover limited stays for respite care when it is part of the recipient’s hospice care.
Eligibility depends on:
- The certification of a terminal illness from a physician who is usually the patient’s primary care doctor (PCP), and a hospice doctor.
- They must accept palliative care in place of curative care and sign a statement declaring the choice of hospice care rather than other Medicare-covered treatments.
Respite care must be inpatient in a Medicare-approved hospital, nursing, or inpatient hospice facility. Read more in our article.
Which parts of Medicare pay for respite care?
Original Medicare Parts A and B, Medicare Supplement (Medigap) Plans, and Medicare Advantage (MA) Plans all cover respite care at variable levels.
|Respite Care Coverage
|Respite care for unlimited stays lasting up to five days at a time. Recipients may be responsible for five percent of the Medicare-approved cost for inpatient respite care.
|Part C (MA)
|MA Plans cover all services covered by Medicare A and B. Many MA Plans offer limited additional coverage options.
|Part D (Prescription)
|Hospice patients opt for palliative care and all maintenance meds are covered by Parts A or B.
|Supplement (or Medigap)
|Supplement Plans cover the copays and coinsurance left by Medicare A and B, and the coinsurance cost share for inpatient respite care is covered by Part A.
What is Respite Care?
Respite care provides short-term relief for primary caregivers. It can be arranged for just an afternoon or several days or weeks and can be provided at home, in a health care facility, or at an adult day center.
What costs are associated with respite care?
Costs for inpatient hospice care, adult day care, assisted living facility care, and in-home care are all part of the price to be paid when a caregiver takes a respite.
Providing for social activities, peer support, and recreation are provided through services like adult day care. Costs vary by location with the highest prices in Maine ($165 per day) and the lowest in Alabama ($31 per day).
Assisted living facilities often reserve rooms for short-term respite care stays and the costs vary depending on the medical and physical needs of the patient. Prices for these facilities vary from state to state, with a low of $103 in Missouri to a high of $230 in Delaware. The average is $152 per day.
In-home care is a broad category that includes homemaker services like shopping and laundry, personal care services, and even some medical care. Costs for any type of in-home care depend on the needs of the individual and the number of hours they require care per day or week.
This also makes in-home care a flexible option for families, as they can choose to hire professionals for those tasks and hours needed. For the average U.S. family, in-home respite care costs about $26 per hour or about $260 per 10-hour day.
Most insurance plans do not cover respite care costs, leaving you to pay for what is not covered by insurance or other funding sources. Medicare will cover a portion of the cost of up to five days in a row of respite care in a hospital or skilled nursing facility for a person receiving hospice care.
There are various sources you may take advantage of, but it will take effort to determine what services you qualify for. These sources may include long-term care insurance, veterans’ benefits, or tax credits. Some states may run voucher programs to pay for respite care providing a set amount of money each quarter.
Does Medicare Advantage Cover Respite Care?
MA Plans cover all services offered by Original Medicare A and B including short-term respite care in a hospice facility. However, respite care can also be delivered in several other ways.
After a minimum hospital stay of three days, recovery in a short-term nursing facility or recovery center from surgery, illness, or accident is covered by most MA Plans. This can offer a needed respite break to this patient’s caregiver. For more information on nursing homes, read this article.
Under certain circumstances, MA Plans may cover in-home care ordered by a doctor. This is another option for caregivers who wish to have a break but prefer their loved one stay at home. For in-home coverage options see Home Health Services Coverage.
Adult daycare is often covered by MA Plans and offers respite care which takes the burden from the caregiver’s shoulders.
What Kind of Respite Care Options Are There?
Following are a few options for respite care; not all are covered by Medicare.
|Type of care
|Adult day care (ADC)
|ADC programs provide a break to caregivers during the day only. Services begin in the morning with the recipient returning home late afternoon or evening, and generally only five days a week during the normal work week. Transportation to and from the care location may be available and the median cost is $80 per day.
|Unlike long-term care which is intended to preserve the patient’s quality of life and health, short-term care is very goal oriented. Respite care is always short-term to give the caregiver a needed rest from their duties.
|In-home respite care
|The care comes to you. It may consist of a companion to keep the patient company and provide safety or a health aid able to bathe, dress, groom, administer medications, and fix meals. The country’s daily average cost for in-home homemaker services is around $130 and for health aid services about $135 per day.
Sources for information on respite care options:
- State Health Insurance Assistance Program (SHIP) offers trusted, unbiased, one-on-one counseling and assistance.
- Eldercare Locator is a public service of the U.S. Administration on Aging that helps locate services related to eldercare including respite care.
Learn More From Our Sources
- Eldercare Locator | Eldercare Locator | Last accessed February 2024
- Medicare.gov | Home Health Services | Last accessed February 2024
- Medicareplans.com | Does Medicare Cover Hospice Care? | Last accessed February 2024
- Medicareplans.com | Medicare Guide for Nursing Homes | Last accessed February 2024
- National Institute on Aging | Caregiving | Last accessed February 2024
- State Health Insurance Assistance Programs | Local Medicare Help | Last accessed February 2024