Does Medicare Cover Respite Care?

Medicare Benefits Solutions
Dec 10, 2020

  • Medicare Part A and Part will cover the cost of most respite care services for hospice patients
  • The respite care must take place in a nursing home, hospital, inpatient facility, or other Medicare-approved facilities
  • Medicare will approve up to five days of respite care at a time
  • You may be responsible for up to 5% of the cost with Original Medicare
  • Additional respite care benefits and coverage may be available with a Medicare Advantage plan

Medicare Respite Care Coverage

Caring for a loved one who is sick or disabled is an act of kindness that requires a lot of work and strength. As advances in medical technology have allowed people to live longer lives, the need for adult care of the elderly has risen across the country.

While anyone providing care for their loved ones in need is thankful for the opportunity to spend more time with family members, the task can become overwhelming. This may result in strain on the relationship between the caregiver and the person in need of care. Additionally, caring for someone who is very sick can be an emotional experience that leads to stress, anxiety and depression for the caregiver.

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Medicare Benefits for Respite Care

Because most cases of needing respite care involve seniors who are in need, it’s common to wonder whether Medicare benefits cover respite care services. While many private insurance providers exclude respite care from their plans, Medicare does provide respite care for up to five days at a time. Respite care can be covered more than once, but according to Medicare, it can only be covered occasionally.

This care is covered only when the loved one in need of care is receiving hospice care in a skilled nursing facility. If the loved one is receiving care at home, Medicare does not usually provide respite care benefits. You also need to pay a 5% co-payment for respite care to cover things like room and board. Keep in mind that Medicare recipients do not receive coverage for room and board outside of hospice situations or situations where someone is admitted to a hospital or skilled nursing facility. As such, long-term care is not provided by Medicare.

Respite care is provided by Part A of Medicare since it involves care that is administered in an inpatient setting. Part B of Medicare may cover outside medical services that are utilized during a stay in a care facility. This may be the case when a physician who is not employed by a facility is brought in to evaluate a medical condition or to administer specialized care. Any medications prescribed or administered during respite care will be covered by Medicare Part A unless the medications are purchased outside of the facility. In those cases, Medicare recipients would receive coverage from Part D.

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What is Respite Care?

To alleviate the stress of such situations, many caregivers turn to respite care services. Respite care is care that’s provided in order to allow the caregiver some time off. In most cases, respite care is provided in a skilled nursing facility or another medical inpatient setting.

Respite care typically takes place:

  • In your home
  • At an adult day-care center
  • Nursing home or another residential program

This allows the caregiver to take a break to reduce stress and handle other life concerns while the loved one in need of care continues to receive medical attention and support. Respite care may only be needed for a few hours or days, but in some situations, a caregiver may need a week or more away from the situation depending upon the circumstances.

TIP: Find out which Medicare plans offer the best benefits for home healthcare, assisted living and respite care services and compare them against your existing coverage.

Does Medicare Advantage Cover Respite Care?

Medicare Advantage plans may offer additional benefits in terms of respite care. These plans provide all of the same minimum coverages as Original Medicare benefits, so you will still be able to take advantage of respite care benefits.  However, you may also be able to receive things like long periods of respite care, discounts on in-home respite care services and a wider network of care providers from which to choose.

TIP: discover 7 reasons to switch your Medicare Advantage plan.

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