Being a caregiver is not easy. It takes a lot of time, energy, and so much more to give care to our seniors and others who need help in their daily lives. Because of that, caregivers get exhausted and burned out from time to time. And for them to recover, they need rest or respite care.
So a common question many people have is, “Does Medicare cover Respite Care?” In this article, we answer this question in clear, plain English. You will also find the average costs of respite care, as well as other helpful info.
Does Medicare Cover Respite Care?
The short answer is yes; Medicare will cover the cost of respite care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your respite care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for respite care costs. However, they will only cover respite care if it is part of a person’s hospice care.
Medicare provides coverage for hospice care both in an inpatient and outpatient setting. But Medicare will ONLY cover respite care if the hospice care is in an inpatient setting. It also requires the setting be a Medicare-approved facility in order for it to cover respite care costs.
Once approved, Medicare Part A will cover the cost of respite care. Medicare Part A will cover up to five days of respite care at a time. While Medicare only provides for short periods of time, there is no limit to the number of stays can get coverage for.
Medicare Part A may cover 95% of the cost for inpatient respite care.
Since you need to be under hospice care for Medicare Part A to cover respite care, here are the general conditions for Original Medicare to cover hospice care:
- You or your loved one has been diagnosed with a terminal illness (a doctor and hospice doctor must give diagnosis)
- The patient must choose to receive palliative care for comfort rather than for treating or curing the condition
- The patient must sign a document that says he/she chooses to receive palliative care rather than treatment-related care.
Here is the scope that Medicare Part A covers in hospice care:
- Inpatient hospital stays, along with the treatment and medications that the patient requires
- A short period of stay at a skilled nursing facility along with medications, rehab care, and daily care
- Limited home healthcare which includes part-time skilled nursing or home healthcare and rehabilitation services
- Hospice care that the patient needs at the end of his/her life.
How Much Does Respite Care Cost?
Respite care usually costs between $150 to $300 per day. The exact cost of respite care will depend on your location as well the service you need.
What Is Respite Care?
Respite care is a short-term break for primary caregivers. It can last for less than a day. Or can last for several days or even weeks. The specifics of what someone providing respite care does varies greatly. It very much depends on your situation and the needs of you/your loved one.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover urgent care?