Medicare’s Coverage of Respite Care in 2019

Medicare’s Coverage of Respite Care in 2019

Danielle Kunkle Roberts authored this article as a guest of Senior Care Corner®. She is the co-owner of Boomer Benefits and a Forbes.com Contributor. Her licensed insurance agency specializes in Medicare-insurance related products, helping tens of thousands of clients across 47 states.

The number of unpaid caregivers in the United States has reached over 40 million, according to the Bureau of Labor Statistics. Often, a caregiving role falls upon a family member whether or not they are prepared to take on the difficult job.

The need for caregivers to have a break by way of respite care is well known amongst senior advocacy groups. Congress heard the plead for respite coverage and acted by passing the Bipartisan Budget Act of 2018. One of the bill’s many additions to Medicare Advantage plans is respite care.

Medicare’s coverage of respite care will depend greatly upon what kind of Medicare plan a patient has. Let’s look at how both Original Medicare and Medicare Advantage plans will cover respite care in 2019.

Original Medicare and Respite Care

Original Medicare’s coverage of respite care was not changed by the 2018 legislation from Congress. Medicare strictly states that it will cover respite care if the patient has a terminal illness with 6 months or less to live. Meaning, a patient must be receiving hospice benefits to get their respite care covered.

Hospice Respite Care

Original Medicare will cover short-term respite care for up to 5 consecutive days. According to Medicare.gov, they will cover additional stays in the case they are not too frequent.

To be covered, the respite care will need to be provided in a Medicare-approved facility such as a hospice facility, hospital, or a nursing home.

Additionally, the care will generally be provided under the following circumstances:

  • The caregiver is facing physical or emotional fatigue
  • The caregiver has an appointment, obligation, or event to attend to
  • The caregiver is ill and can no longer take care of the patient on their own

Cost with Original Medicare

Fortunately, if the patient meets Medicare’s criteria, Part A will foot most of the respite care bill.  Typically, the patient will only be responsible for covering 5% of the Medicare-approved amount.

To break down an example of this, if Medicare approves $100 per day for inpatient respite care, this would leave only $5 per day for the patient to pay while Medicare picked up the rest.

Beneficiaries enrolled in Medigap plans may find that their plan covers the 5% coinsurance for them.

Medicare Advantage and Respite Care

Notably, Medicare Advantage (MA) plans have seen the biggest change from the Bipartisan Budget Act of 2018. Respite care is one of the additions now allowed. If a carrier decides to include some of these new supplemental benefits to its plan design, it will usually allocate a set dollar amount and/or credit a certain number of hours of respite care that will be covered.

The respite care options that can be covered by some Medicare Advantage plans include:

Short-term residential facilities

Many assisted living facilities, nursing homes, and hospice centers offer short-term respite care as a service. There are typically rooms in these facilities that are specifically designed for temporary stays by their respite patients.

In-home respite care

In-home respite care is a great option for caregivers that need a temporary break but are in a situation where the patient cannot leave the home.

Adult day care

Caregivers can schedule respite care through an adult day care on occasion or a set schedule. This is a great change of pace and scenery for the patient while giving the caregiver a temporary break.

It is important to stress that not every MA plan will offer respite care coverage. There are still many plans that have yet to offer this coverage. With 2019 being the first year that plans can offer this coverage, analysts believe many more plans will offer the benefit in the future.

Summary

Respite care is a practical and necessary break for caregivers. This unpaid role can feel daunting to the caregiver at times and even cause stress on the patient. The newly available coverage of respite care through Medicare Advantage plans will be a welcome benefit to many beneficiaries and their family members.

2 thoughts on “Medicare’s Coverage of Respite Care in 2019”

  1. Im going to a full hip replacement surgery on May 2nd I take care of my Mom she is 86. Would this coverage help with my situation?

    • Getting home care or short term placement when you are undergoing surgery may be covered. Check with a facility like ALF or LTC in your area and ask to speak with the social worker who can walk you through the possibilities. Good luck!

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