Does Medicare Cover Respite Care?

We all need a little rest from time to time, but for those who act as primary caregivers for their loved ones, rest may be difficult to come by. It may be even more elusive if your loved one has a critical condition that requires constant supervision and care.

Respite care can help caregivers find some relief. Of course, any kind of specialized care will cost money, but will Medicare help pay for respite care?

What is Respite Care?

Respite care, in essence, is a service that takes some of the responsibility of care off caregivers. After all, caring for someone who needs assistance with daily tasks, medical interventions, or supervision can be both a physically and emotionally draining responsibility, especially if it’s part of a hospice care program, when the loved one isn’t expected to survive their diagnosis. Caregivers may need short times of relief to avoid burnout and health issues themselves.

In practice, respite care can happen in one of two ways. Someone can come to the home of your loved one to cover your duties or your loved one can go to an inpatient facility or even an adult daycare for a short time while you rest. This service can help with care for a single afternoon, several days, or even weeks.

When Will Medicare Cover Respite Care?

Medicare will only cover respite care for a caregiver if it’s part of overall hospice care for a Medicare beneficiary. This sets hospice care apart from other services covered by Medicare, because it is one of the few services that has benefits that extend to a beneficiary’s family (e.g., Medicare helps cover family grief counseling in this case as well). The reason why Medicare and other insurances often don’t cover respite care is because it doesn’t directly help the beneficiary and isn’t specifically a medical service. Hospice care, on the other hand, can and does directly benefit the beneficiary, offers aid for the caregivers, and covers some services that aren’t traditionally considered to be medically necessary in nature (e.g., spiritual counseling).

If your loved one is enrolled in Medicare and is undergoing hospice care, you may be entitled to some coverage for respite care. In order to receive coverage, the respite care must be given in a Medicare-approved inpatient facility, meaning the loved one is given their hospice care there while you are given time to rest. Respite care can last up to five days at a time and can happen more than one time each year, though only on an occasional basis. The respite care may last up to five days for each instance of respite care, not in total. You may be subject to a small copayment of five percent of the Medicare-approved amount per stay.

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Caring for an ailing loved one can be exhausting, frustrating, and heartbreaking. While you probably wouldn’t want to trade those moments with them for anything, having time to rest and recuperate can be important to your health and your ability to remain a caregiver. Knowing that Medicare offers you a chance to do so, even for a short time, can mean everything.