Medicare Benefits for Respite Care

If you need a break from caring for a seriously ill patient, Medicare can come to the rescue by paying for respite care. You qualify only if the patient is terminally ill and already receives hospice care in the home through Medicare. Medicare also places certain restrictions on respite care, including the number of days you can take at one time.

Insurance Requirements

Both hospice and respite care come under Medicare Part A hospital coverage. The patient qualifies with original Medicare Part A or Medicare Part C, also called an Advantage plan. Advantage plans combine the coverage of Part A hospital insurance and Part B medical insurance in one policy through a company that contracts with Medicare.

Approved Facilities

For Medicare to pay for respite, the patient must go to a Medicare-approved inpatient facility, such as a nursing home, hospital or hospice house. Medicare does not pay for in-home respite care or adult day care.

Some hospice providers maintain their own respite facility and can facilitate the transfer to inpatient care. You also can ask you physician for recommendations, or use the online respite locator tool from the ARCH National Respite Network.

Time Restrictions

You're allowed a maximum of five consecutive days of respite care at one time. You can take respite care more than once, but it's intended to be "occasional," not continual, according to the Medicare.gov website.

Medicare's Portion of the Bill

Part A or Part C Medicare covers 95 percent of the cost of the Medicare-approved amount for respite care. The sum that Medicare allows may be less than the standard billing amount, but approved facilities agree to accept what Medicare approves. The person responsible for the patient's bills may then have to pay the remaining 5 percent.

If the patient has supplemental insurance, also called Medigap, this supplemental insurance may cover the remaining costs.

If you exceed the five-day limit, Medicare will pay for excess days at the in-home care rate, not the inpatient rate.

Using Respite

Respite gives you a chance to recharge mentally and stay well physically, so you can continue providing in-home care with the help of hospice services.

Tip

The ARCH National Respite Network recommends you take respite care proactively, before you're completely worn-out or become ill yourself.

To get the most benefit from your time off, plan activities that you particularly enjoy or that will help minimize stress in your life, as ARCH recommends:

  • Spend time with friends.
  • Garden or get things done in the home.
  • Indulge in your hobbies, such a painting, sports or reading.
  • Take a short vacation for a complete change of scene.
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