Does Medicare Cover Respite Care?
- Find out when Medicare covers respite care and how much you may have to pay out of pocket. Learn about the costs of respite care and how to take advantage of it.
The Family Caregiver Alliance reports that more than an estimated 43.5 million Americans provide unpaid care for relatives. If you're one of them, you know all too well how physically and emotionally exhausting serving as a loved one's primary caregiver can be.
Respite care lets you take a break while knowing that your family member is receiving the care and support they require. For certain individuals, Medicare even covers some of the cost of this valuable service.
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Does Medicare Cover Respite Care?
Medicare Part A covers 95% of the cost of respite care stays in approved long-term care facilities for up to five days for individuals deemed eligible for hospice care. You're typically required to pay the remaining 5% of the cost.
Medicare Advantage (Medicare Part C) plans are sold by private insurance companies, and they're required to provide at least the same benefits as Medicare Part A and Part B (often called Original Medicare). Some Medicare Advantage plans may offer additional benefits not covered by Original Medicare, and some plans may offer more respite care or caregiving services than Original Medicare would cover.
What Is Respite Care?
Respite care is a temporary stay in a long-term care facility. The purpose of the stay is to allow a primary caregiver to rest and see to personal matters. Many assisted living facilities and nursing homes offer respite care.
What Is Included in Respite Care?
The cost of respite care typically includes:
- Around-the-clock supervision by trained long-term care staff
- Assistance with daily living tasks such as bathing, dressing and eating
- Medication management
- Meals and snacks
- Housekeeping services
Nursing homes and personal care homes may provide additional services for the base price of respite care or offer extra services for additional fees.
Who Is Eligible for Respite Care Under Medicare?
To receive coverage for respite care, a person must meet Medicare's hospice eligibility requirements by:
- Having a terminal illness
- Receiving a life expectancy estimate of 6 months or less
- Obtaining certification from both hospice and primary care physicians that the above two statements are true
When someone receives approval for hospice from Medicare, the focus of care shifts from attempting to cure the illness to keeping the individual comfortable through palliative care.
How Often Does Medicare Pay for Respite Care?
Medicare coverage of respite care may include multiple respite care stays at approved long-term care facilities. Guidelines state that stays can only take place "on an occasional basis" and don't define the term further.
How Much Does Respite Care Cost?
Typically, you pay for respite care on a daily basis. Pricing is usually similar to the pricing for typical long-term care services. LongTermCare.gov reports the following average prices:
- $225 per day for a semiprivate room in a nursing home
- $253 per day for a private room in a nursing home
- $119 per day for a one-bedroom room in an assisted living facility
The price for respite care varies based on where you live and which facility you choose.
Do Medicare Advantage Plans Cover Respite Care?
Medicare Advantage plans are required to cover as least as much as Original Medicare. As a result, if your loved one would be eligible for respite stay coverage under Medicare Part A, the plan must also provide similar coverage. Some plans may even allow for longer stays or pay for a greater percentage of the cost.
You can compare Medicare Advantage plans online to see if any plans in your area offer additional respite care benefits or caregiving services.
Do Medigap Plans Cover Respite Care?
Medicare Supplement (also called Medigap) plans don't cover any type of services performed in long-term care facilities, including temporary respite care, according to Medicare.gov.
Medicare Supplement plans work alongside your Original Medicare benefits to help pay for Medicare coinsurance, copays and other out-of-pocket costs when you get Medicare-covered care.
How Do I Get Medicare Coverage of Respite Care for My Loved One?
To get respite care for your loved one, you'll first need to receive hospice certification through Medicare. Once you have submitted the necessary certificates, you can contact nursing homes and long-term care facilities in your area to find out if they have space available for respite care. Medicare offers a search tool to help you quickly find approved providers in your area.
