Are respite care services covered by Medicare?

are respite care services covered by medicare?

nurse reaching out to senior woman

Sometimes numbers tell the story best. Each year, more than 53 million family caregivers provide the majority of support that makes it possible for older people and people with disabilities to live in the community.

And that caregiving can be both tremendously rewarding but also stressful and physically and emotionally exhausting.

That’s where respite care comes in. Respite care allows a caregiver to rest or take a break while the person in their care stays in a hospital or other facility, or is cared for at home by someone else. Accessing respite care services can provide caregivers with a much-needed temporary break that can be beneficial for both caregiver and the care recipient.

“Respite care is a big deal because it pays for a short-term break when the family caregiver needs a breather to maybe run errands or just briefly get away,” said Bernadette Harris, owner of Arizona-based Sierra Medicare Solutions. “Being a full-time caregiver, especially if you’re a spouse and you’re giving full-time caregiving, you need a break … the work can play on your anxiety, tiredness and loneliness.”

The reality, though, as Harris pointed out, is that paying for respite care can be a challenge for seniors and their caregivers.

Does Medicare cover respite care services?

Traditional Medicare only covers respite care under the hospice benefit.

Hospice care commences when a senior’s regular doctor or hospice doctor has certified that he or she is terminally ill (six months or less to live). Additionally, this respite care is for inpatient care only, in a skilled nursing facility or hospital—Medicare won’t pay for respite care at home. Although an individual can receive Medicare-covered respite care more than once during hospice, each stay can only last five days. It’s possible a senior might need to pay a small co-payment for each respite care stay.

Are there other funding options for respite care services?

If your older adult is not eligible for Medicare-covered respite care as outlined above, there are other funding options you may want to consider.

Medicare Advantage

Medicare Advantage, the private plan alternative to traditional Medicare, will provide for respite care in some cases, according to Jill Kagan, director of the ARCH National Respite Network and Resource Center (an agency federally funded by the Administration for Community Living, part of the U.S. Department of Health and Human Services).

The types of benefits allowed under these plans generally fall into a few categories: adult day care services, home-based palliative care, in-home support services and support for caregivers—which is essentially respite services.

Medicaid

Medicaid does not cover respite care under its general benefits program. However, many states have waiver programs that can be used to help cover the cost. Check your state’s Medicaid guidelines and waiver programs to see if your state offers respite care benefits.

Medicaid is actually the largest federal source of funding for respite care, but it may be hard to qualify under the income guidelines—and there are often long waiting lists, according to Kagan.

Lifespan Respite Care Program

This small, federally funded service awards money to states to build respite care systems, aims to help families pay for respite care and helps states recruit and train respite providers, Kagan said. This program “serves as a gap-filling program,” she said. “States are largely using these funds to help family caregivers who don’t qualify for other publicly funded programs.”

Area Agency on Aging / National Adult Day Services Association / Local organizations

One of these agencies may be able to connect you with services in your area, or other local resources may be available. Some senior centers and churches provide adult day care services, often on a sliding-fee scale, especially in low-income areas where there’s more access to government funding for aging services. Contact your local houses of worship and senior centers to see if any respite care assistance is available near you.

Adult day service organizations

Also known as adult day care, these groups generally offer supervision and meals during the day.

Respite care organizations

Search for agencies in your area that may provide services at low or reduced costs.

State Health Insurance Assistance Program

Your State Health Insurance Assistance Program (SHIP) can be a source for assistance and counseling.

U.S. Department of Veterans Affairs 

All enrolled veterans are eligible for respite care if they meet the clinical criteria for the service and it’s available. If the respite care is provided by a community agency, adult day health care center or nursing home, the veteran also needs to meet community care eligibility.

Long-term-care insurance

This type of private insurance typically covers respite care, but policies differ in what exactly they will cover so be sure to check the details of your plan.

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