How Does Medicare Respite Care Work?

Respite care is a break for caregivers who are helping see to the needs of an elderly or disabled person on a constant basis. These caregivers simply cannot dedicate themselves to caring for another person 24/7 and need a break for practical reasons as well as for their own mental, emotional, and physical health. This is where respite care steps in.

Respite care works as backup support for the primary caregiver. Usually, respite care is for a short period of time, from a few days to a few weeks. Respite care can happen in-home or at a facility.

If the person who needs care is on Medicare, there might be some options to get coverage from Medicare for respite care expenses.

Does Medicare Cover Respite Care?

Medicare covers respite care but there are some conditions that must be met. Your respite coverage also depends on what type of Medicare you have.

People with Original Medicare Part A and Part B, qualify for respite coverage as part of their hospice care. That means that the patient has a terminal illness, hospice doctor, or they’re seeking palliative care.

Also, even though respite care can be provided at home, to be approved by Medicare Part A, the care needs to happen in an inpatient facility that is Medicare-approved. Patients can receive covered care for up to five days. In some situations, a co-payment of 5% of this care is passed on to the patient.

Does Medicare Advantage Cover Respite Care?

Medicare Advantage, otherwise known as Medicare Part C is available through private insurance companies. This means Some benefits may vary, but the basic package is the same. . Some of them cover respite care and some do not. If this is important to you, then you want to enroll in an Advantage program that covers respite care. Each plan is a little different, so you need to dig in and review the details before signing up.

What Is Included in Respite Care?

There are different types of respite care, different locations where respite can occur, and different time frames. If you’re looking for Original Medicare coverage for respite care, those options become much more limited.

To have Medicare coverage, respite care needs to be done on an in-patient basis in an approved nursing or hospice facility. There the patient will receive access to round-the-clock care and all of the necessary help and treatments that they need.

There are other types of respite care, including shorter-term care, longer-term care, and in-home care but those will not be covered by Original Medicare. A Medicare Advantage program might pay for these respite situations, or you can choose to pay for them out of pocket.

How Much Does Respite Care Cost through Medicare?

Senior Living estimates that respite care at an in-patient facility is roughly $255 per day for a semi-private room and $290 for a private room.

Since Medicare only allows for a stay of up to five days of respite care, that price will likely be in the range of $1275 to $1450, but most of that will be covered by your Part A and Part B insurance. Medicare does require a 5% payment from some people, which would put their out-of-pocket expenses at $63.75 to $72.50.

Having in-home help and/or temporary assistance is less expensive, but those types of care are not covered by Original Medicare Part A and B.

Does Medigap or Medicaid Cover Respite Care?

You might find additional help paying for respite care with a Medigap policy or Medicaid, but this depends on where you live for Medicaid coverage and the type of Medigap policy you have.

Medigap

Medigap is sold by private insurance companies to people who have Original Medicare Parts A and B and is used to fill in gaps in coverage. Because Medigap is provided through a private insurance company, it may or may not cover respite care, depending on the policy you’ve selected. There’s no standard for the “gap benefits” so it pays to shop around when purchasing Medigap.

Medicaid

Medicaid coverage of respite care depends on what state you live in and receive your benefits from. Medicare benefits are determined by the state. If your state’s Medicaid pays for respite, the benefits can be found under the Home & Community-Based Services waivers.