Does Medicare Cover Respite Care?
Caregiving can be emotionally and physically draining. It often leads to issues such as stress, anxiety, and caregiver burnout. A recent study shows that 36.7% of older caregivers don’t get enough sleep, which can negatively impact a person’s health. Respite care provides temporary relief to caregivers so they can rest and take care of themselves.
Medicare has limited respite care coverage. It only covers respite care if you qualify for hospice care. In this blog, we’ll cover Medicare respite care coverage during hospice, the associated costs, and the eligibility criteria for hospice care.
Key takeaways:
Medicare covers caregiver respite care if beneficiaries are receiving hospice care.
Medicare also covers short-term home health services under certain conditions, which may provide a different type of caregiver support.
What is respite care?
For the 53 million caregivers in the US, respite care can provide much-needed relief from their demanding duties. Unfortunately, some caregivers sacrifice their own health and wellness needs while caring for others. Respite care provides caregivers with a temporary break from caring for a loved one. To take the break, caregivers can arrange care for loved ones through a healthcare facility or adult day care center.
Respite care allows people to regain strength and manage personal responsibilities. Whether they need a break for a day or several weeks, a caregiver can schedule respite care according to their needs.
Does Medicare cover respite care?
Medicare only covers respite care for people receiving hospice care. Caregivers of patients with conditions like dementia or cancer don’t qualify for respite care coverage, unless the beneficiary is in hospice.
Medicare Part A covers hospice care. Medicare beneficiaries are eligible for hospice care if a doctor determines that they have a terminal illness.
Caregivers can also receive respite care through home health care. Medicare covers home health care if you’re “homebound.” Being homebound means a health condition or injury prevents you from leaving your home. In cases of surgery recovery or short-term illness, you can receive in-home skilled nursing care along with help from a home health aide. These services can provide caregivers with a form of respite care.
Medicare coverage for respite care during hospice
If your loved one is eligible for respite care because they’re in hospice, there will be some out-of-pocket costs to cover the respite care services. You may have to pay 5% of the costs of inpatient respite care. The copay or coinsurance can’t exceed the hospital deductible for the year.
To receive hospice care, you must use a Medicare-approved hospice care provider. This provider approves respite care and arranges services with a nursing home, hospice inpatient facility, or hospital.
Other options for respite care
Other respite care options include:
Hiring an in-home professional caregiver, home health aide, or skilled nurse
Reaching out to community organizations that offer volunteer caregiving services
Using residential facilities, like nursing homes or assisted living facilities
Enrolling loved ones in adult day care centers
Here are additional resources that may offer support for caregiving and respite care:
Additional insurance, like VA benefits, may cover caregiving and respite care services. If you have further questions about Medicare coverage and options for respite care, call a licensed Medicare Advisor at 855-900-2427 or schedule a time to talk.