How Does Medicare Cover Respite Care?

| End-of-Life Resources

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When you think of care that is provided to a patient, you typically think the reason for the care is to help the patient. However, respite care actually benefits the patient’s caregiver more than the patient themselves.

Respite care is a type of care that is provided to a patient so that their caregiver can rest for a short period. The care that the patient receives while the caregiver is away is very similar to the type of care that the caregiver provides on a daily basis.

Trained professionals care for the patient any many ways. Depending on the type of care the patient needs, the care providers may help them bathe, eat, get dressed, administer medications, and more. The care providers can even provide your loved one with companionship during your break.

Ways Medicare Covers Respite Care

For a Medicare beneficiary, there are two ways they could possibly receive respite care coverage. The first way is through your Original Medicare Part A hospice benefits. You can only get this type of respite care covered under certain circumstances.

The second way is having it covered by a Medicare Advantage plan. Though, not all Medicare Advantage plans offer respite care coverage yet. We’ll explain.

Original Medicare

When a Medicare beneficiary has qualified for and elected to receive hospice care, their caregiver becomes eligible for respite care. If the beneficiary’s doctor has certified them as terminally ill and the beneficiary has elected hospice care over treatment for the illness they suffer from, then respite care will be covered under the Part A hospice benefit.

Although Medicare beneficiaries pay nothing for hospice care under Part A, they may be responsible for a 5% coinsurance for respite care. If they have a Medigap plan that covers the Part A coinsurance, then they could likely not owe anything for respite care services.

Under Medicare Part A, you can receive respite care at a hospital, in-patient hospice care center, or a nursing home.

Medicare Advantage

Medicare Advantage plans make up Medicare Part C. These are plans sold by private insurance carriers such as United Healthcare, Blue Cross Blue Shield, and Aetna – not the federal government. Because Medicare Advantage plans are created and sold by private insurance carriers and not Medicare, each plan can be customized to the carriers’ discretion.

As long as federal minimum guidelines are met, the carriers can design the rest of the plan benefits however they see fit.

Medicare Advantage plans are allowed to offer certain extra benefits not covered by Medicare. This is one reason why some people elect a Medicare Advantage plan over plain Original Medicare.

Recently, the Centers for Medicare and Medicaid Services (CMS) gave permission for Medicare Advantage plans to now include new supplemental home are benefits that are not covered under Original Medicare Parts A and B.

The Part C  Medicare Advantage plans many now begin to include things that would provide the caregiver a respite, such as in-home supplemental benefits, custodial care, meal delivery, transportation to and from medical appointments, and even adult day care.

Since every Medicare Advantage plan is different, the copays and coinsurances you pay to access this benefit will be dependent upon your plan specifically.

Other Ways You Can Receive Respite Care

Medicare beneficiaries who are not terminally ill and don’t have a Medicare Advantage plan that covers respite care won’t be able to get respite care covered under Medicare. However, there are other avenues they can take to find respite care at a hopefully reasonable price.

Facilities that might offer paid respite care are adult day-care centers, residential centers, and assisted living facilities. There may even be a company in your area that provides in-home respite care services.

If you don’t have access to any of these options, or if they don’t work with your budget, try asking another family member that you trust to look over your loved one while you’re away.


| End-of-Life Resources

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