Does Medicare Pay For Respite Care?
Respite care is a vital resource for caregivers. The demands of the role are high. Getting a break from the responsibilities and duties of caregiving helps individuals stay well and provide better care.
If you care for a loved one who qualifies for Medicare, they may qualify for respite care coverage. In this article, we talk about:
- What respite care is
- When Medicare covers the costs
- Why it matters if your loved one is in hospice care
- Alternative ways to cover respite care costs
Do you need more information about respite care and caregiving? Use this link to find out if you have free access to Trualta’s caregiving resources and supportive caregiver community.
What Is Respite Care?
Respite is temporary care for a care recipient who is receiving all or most of their care from a family caregiver. Respite gives the primary caregiver a break and time off. Many family caregivers don’t otherwise have an opportunity to take time away from their responsibilities.
The responsibilities and demands of caregiving are high. Caregivers benefit from respite because it gives them time to engage in self-care, socialize, or simply rest and do activities they enjoy. Care recipients also benefit from respite care. The time away helps their caregiver stay healthy, both mentally and physically. This means they can provide better care when they return.
Original Medicare Covers Respite For Hospice Care
Original Medicare includes Parts A and B. Original Medicare Part A includes respite care but only for patients receiving hospice care. This limitation excludes a lot of patients and caregivers. However, it’s very useful for caregivers of hospice patients. Family caregiving is demanding, but it can be especially difficult and stressful when the patient is nearing the end of their life.
What Is Hospice Care?
Hospice care is end-of-life care. There are many misconceptions about hospice care. Families often hesitate to begin hospice care because of the finality. Patients benefit significantly from this type of care, so there is no reason to delay it if your loved one qualifies.
Hospice providers focus on maximizing your loved one’s quality of life. Loved ones no longer receive treatment for their illness; instead, they receive treatments designed to manage symptoms like pain. Hospice includes medical care, mental health care, therapy, spiritual care, family support, education, and other types of support.
What Are The Eligibility Requirements For Medicare Coverage of Hospice Respite?
If your loved one is already receiving or qualifies for the Medicare hospice benefit, they are also eligible for respite care. To receive the hospice respite care benefit, your loved one must meet these qualifications:
- A physician and hospice doctor must certify that your loved one has a terminal illness with an approximate life expectancy of six months or less.
- The hospice patient must be willing to receive palliative care instead of curative care for their illness.
- The patient must make a signed statement declaring they choose hospice over other types of Medicare-approved treatments.
What Does The Medicare Hospice Benefit For Respite Care Include?
Respite care for a hospice patient includes all the necessary care for that individual. The patient is checked into an approved facility and receives round-the-clock medical care, personal care, and supervision for the duration of their stay. This is provided by the hospice team or other qualified staff.
Medicare Part A hospice benefits include five consecutive days of inpatient respite care. The benefit is designed for occasional use, up to five days at a time, but there is no actual limit on how often the benefit can be used for qualifying patients.
Medicare hospice care, including respite services, must take place in an approved skilled nursing facility. Medicare will not pay for in-home respite care or care in an unapproved facility.
Coverage includes 95% of the cost. The patient is responsible for a 5% copay, which cannot be more than the yearly inpatient hospital deductible. You can use Medigap insurance to help pay this additional cost. Medigap is Medicare Supplement Insurance, a type of insurance your care recipient can purchase from a private insurer. It covers many out-of-pocket costs, like this copay.
Medicare Advantage Plan & Respite Care
Medicare Advantage (Part C) covers all the same basic services as original Medicare. It also includes some extra benefits. Some Part C plans cover adult day care, home health care, and other caregiver support services, like meal delivery and transportation. These can be used as respite care.
For example, your loved one’s Part C plan may include adult day services. If so, you can take them to an adult day care center for a few hours or an entire day. This allows you to have respite for a short period of time. If you have in-home care coverage, you can benefit from having a professional in the home for some time.
Supportive services, like meals and non-emergency medical transportation, are not exactly respite care. However, if you have coverage for these services, they can support your care and make your duties a little easier.
Part C Medicare plans vary, so checking your loved one’s plan for important details is important. The plan will outline premium amounts, copays, deductibles, and services covered. Staying in network typically costs less. As with original Medicare, Part C coverage is 95%, leaving you and your loved one responsible for a 5% copay. Medigap is not available for a Medicare Advantage beneficiary.
Other Ways To Pay For Respite Care
If your loved one does not have Medicare coverage, you can find other ways to pay for some or all respite care costs.
Medicaid
If your loved one qualifies for Medicaid, you may be able to use it to help pay for respite care. Medicaid doesn’t generally cover respite, but most state programs have home and community-based services (HCBS) waivers.
HCBS waivers represent extra coverage beyond the standard Medicaid programs. Qualified beneficiaries can use HCBS waivers for various services based in the home or community. They’re supposed to help keep people in their homes longer and delay the transition to nursing homes or assisted living.
If your loved one qualifies, you could use HCBS waivers to cover respite care. For more information, check with your state’s agency that administers Medicaid benefits.
Veteran Benefits
Your loved one may qualify for Department of Veterans Affairs (VA) benefits if they’re a veteran. The VA offers healthcare benefits to qualifying veterans. It also offers respite care, which may include coverage for in home care, adult day care services, or nursing home care. Contact your local VA office to learn more.
Additional Support
Your loved one may not qualify for Medicare, Medicaid, or VA benefits. In this case, you can always pay for respite care services out of pocket. You can also find other sources of support to help cover the costs.
Many states have State Respite Coalitions, for example. These organizations represent caregivers and care recipients and help families find resources for respite care. Contact your state’s office to see how they can help.
Many states also have Lifespan Respite Care Programs, or LRCPs. Your state’s LRCP provides vouchers and grants for respite care costs. This link will help you find the LRCP if available in your state.
Finally, contact your local Area Agency on Aging (AAA) for information about the National Caregiver Support Program. The program provides funding for respite care for qualifying individuals, including caregivers for older adults, young children, or adults with disabilities.
Respite care is a vital service for both caregivers and care recipients. If you care for a family member and could use relief, look for quality respite services in your area. Medicare can be a great resource for covering this care, but it’s not the only one. Contact these other organizations to find different ways to pay for and benefit from respite.
Do you need more information about respite care and caregiving? Use this link to find out if you have free access to Trualta’s caregiving resources and supportive caregiver community.
References
- https://www.medicare.org/articles/does-medicare-cover-respite-care/
- https://www.nia.nih.gov/health/hospice-and-palliative-care/what-are-palliative-care-and-hospice-care
- https://www.ncoa.org/article/does-medicare-cover-respite-care/
- https://www.medicare.gov/health-drug-plans/medigap
- https://archrespite.org/caregiver-resources/how-to-pay-for-respite/
