Does Medicare Cover Respite Care?
Posted: April 03, 2024
Caring for an older loved one involves demanding tasks like daily custodial care and household chores. These responsibilities can require a lot of mental and physical energy, necessitating occasional breaks to focus on self-care, relieve stress and ensure you are fully present when you return.
When you step away, the person who relies on you needs uninterrupted support from knowledgeable and caring people. If your loved one is a Medicare recipient, respite care coverage can fill the gap. Let’s explore the terms and benefits of respite care and the associated payments.
What Is Respite Care Coverage?
Respite care is a period that allows a primary caregiver a hiatus from looking after a patient or older loved one. Depending on your health care provider, this interval may last one afternoon or several weeks. Various people can provide respite services, including relatives, friends, professional caregivers, nurses and community volunteers.
The patient will typically spend this time in a hospital or similar facility that complies with their needs. This setting can include their home, an adult day care or an assisted living facility. Here’s a more in-depth look at how they work.
- In-home respite care: Caregivers come to patients’ homes to look after them for a few hours, helping with dressing, feeding, bathing and administering medication.
- Adult day care: This option is excellent for patients who require constant monitoring but are still fairly active. These facilities allow older adults to exercise and socialize. They may receive health monitoring, transportation, meals and additional support services.
- Nursing home or assisted living center: These facilities reserve rooms for temporary respite stays, making them ideal for caregivers who need a break for several consecutive days.
Does Medicare Cover Hospice Care?
Your loved one may need hospice care if their doctor certifies that they are terminally ill with six or fewer months to live. Medicare’s hospice care coverage comes with specific considerations.
For instance, Medicare Part A may only cover 95% of the respite care cost, leaving the patient responsible for the remaining 5%. Additionally, this hospice care must occur in a Medicare-approved inpatient facility, nursing home or hospital.
Each outpatient prescription requires a copay of $5 or less, depending on the medication. If your loved one’s hospice benefits exclude the necessary medication, your hospice provider may coordinate with their plan to determine if they offer additional benefits to cover it.
Benefits of Respite Care From Medicare
A patient’s hospice team will usually create a care plan that allows your loved one to live as comfortably as possible during this challenging time. Some aids and services the Medicare-approved hospice facility will offer include:
- Medication for symptom and pain management
- Doctors, nursing and medical services
- Quality medical equipment and supplies for symptom management and pain relief
- Occupational and physical therapy services
- Meals and snacks
- Assistance with daily living tasks like bathing, eating and dressing
- 24/7 supervision from knowledgeable staff
- Dietary counseling
- Family grief and spiritual counseling
- Housekeeping services
- Speech-language pathology services
How Much Does Respite Care Cost Through Medicare?
Medicare only covers respite care that occurs in a Medicare-approved facility, such as a nursing home, hospital or hospice, rather than a patient’s home. You may need to cover these costs out of pocket when your loved one requires respite care for more than five days or needs in-home services. Otherwise, your Medicare respite care costs will vary depending on your agency, area and required services.
Here are the national average costs for care services in the U.S., according to longtermcare.gov.
- Assisted living facility: A one-bedroom unit will cost $119 per day.
- Semi-private nursing home room: This room will cost $225 for a single day.
- Private nursing home room: This service may cost $253 a day.
- Adult day care center: These adult health centers require you to pay $68 per day.
- Homemaker services: These require an hourly rate of $20.
- Health aide: This service will cost $20.50 per hour.
If Medicare agrees to pay for your loved one’s hospice care, you may only owe 5% of the Medicare-approved amount. This copay should stay within the inpatient hospital deductible for the year. Medicare may also require you to contribute up to $5 toward each prescription medication. They will inform you if you need to pay for any ineligible services or medications out of pocket.
Talking with your health care provider is the best way to determine your overall cost when you combine all the services. This specific cost will depend on:
- The type of facility
- If the doctor accepts the assignment
- How much the doctor charges
- Where you receive your service, test or item
- Any additional insurance you have
How to Pay for Respite Care
While most people will pay their portion of the respite care out of pocket, you can get third-party assistance if you have a limited household budget and need help with your caregiving responsibilities.
If you have a long-term care insurance policy, contact them to learn if it covers respite care. You may also check if they include veteran benefits if your loved one served in the military. Additionally, you may seek relief from respite care grants and experts who can help you get the necessary support.
Get Respite Care Coverage With Assistance From Health for California
Whether your loved one has already enrolled in Medicare and needs respite care or you’re considering enrolling them in Medicare, respite care coverage has worthwhile advantages. Maximizing your loved one’s health plan requires careful decision-making and guidance.
Health for California’s experts work to understand your unique situation. We will help you choose the appropriate coverage and providers to secure comfortable respite care. Contact our experts today for assistance and advice to minimize your out-of-pocket costs and ensure the older adult you care for receives excellent care in their final days.