What to Know about Medicare Insurance and Respite Care

While being a caregiver for a loved one is undoubtedly rewarding, it can also get overwhelming and you may suffer caregiver burnout. Respite care can be a great help, allowing you to take a physical and mental break from your caregiving responsibilities. The good news is that Medicare insurance may cover respite care under some circumstances.

Respite Care with Original Medicare Insurance

Part A of the Original Medicare insurance plan covers inpatient care. As such, part A may cover an inpatient stay for respite care in a nursing home or hospital, but only if the Medicare insurance beneficiary is on hospice care.

To qualify for hospice care, the beneficiary must meet several criteria. First, the beneficiary must be terminally ill, that is, they have six months or less to live. The beneficiary must accept care that improves the quality of life instead of treating the illness and sign a written statement.

Worth noting is that Original Medicare insurance will not pay for respite care at home. Again, while Medicare will cover respite care during hospice more than once, there is a limit in that each stay can only last up to five consecutive days.

Respite Care with Medicare Advantage

Medicare Advantage, also known as Part C Medicare insurance plans, offers some added benefits. One such benefit is family caregiver support. While not too common, some part C plans offer accessible respite care. 

The specifics of what and how much coverage you can expect towards respite care will depend on your plan. Some plans will include respite care as in-home respite care, short-term care in an approved facility, and respite care in an adult daycare.

Understanding Respite Costs

Respite care costs are typically billed by the hour or the number of days. How much it will cost depends on several factors. The first is whether or not you are getting at-home or inpatient care. The average costs will also depend on where you and your loved one live. 

Again, the costs will depend on how much help and care your loved one needs, with complex medical care being more expensive than the costs for assistance with daily living activities. As mentioned, some Medicare Advantage plans cover adult daycares, in which case, respite care is unsurprisingly less expensive than respite care on an individual basis.

In Closing

As highlighted, Original Medicare insurance only covers respite care as part of hospice care. You can also look at your Medicare Advantage plan. This is a big plus as respite care can be expensive to pay out-of-pocket. To learn more, contact a Medicare insurance provider in your area such as American Eagle Health Insurance.