Medicare and Respite Healthcare

Medicare healthcare

As of 2021, the Centers for Medicare and Medicaid Services for Medicare Advantage plans approved new respite care benefits. Since the guidelines were issued so late in the year of 2018 after most insurers had already released their 2019 plans, CMS expects a much larger number of Advantage plans to offer supplemental benefits in 2020.

Now that the Annual Election Period is right around the corner and Advantage plans are making changes to their levels of coverage and benefits for 2020, we’ll start to see a spike in more Advantage plans providing respite care benefits.

What is Respite Care?

Think of respite care like substitute teachers. For someone who is the primary caregiver for a family member or loved one, respite care is the help you request to take your place as a caregiver when you need a break. You can hire these trained healthcare providers to take on caregiver duties such as basic care, administration of medications, and even tube feedings.

Depending on your situation and what kind of duties are needed, respite care can be provided in various settings. For instance, respite care can take place in an inpatient hospital, at home, a long-term care facility or even an adult daycare. You can hire respite care for just a few hours or for a few days.

Medicare Coverage of Respite Care

Medicare covers respite care, but there are some conditions. Medicare Part A covers respite expenses when the beneficiary has enrolled in hospice care. Respite care is covered by Part A as part of your hospice care benefits.

Part A only provides coverage for respite care in a hospital inpatient setting. Such care is not covered in a long-term care facility or skilled nursing home. Inpatient respite care is covered by Part A for as long as five days, however, there may be a 5 percent coinsurance amount that you’ll have to pay.

It’s important to note that these benefits are limited and can only be used occasionally. Really pick and choose the moments you want to use these benefits.

Medicare Advantage Coverage of Respite Care

Medicare Advantage plans are entirely separate from Original Medicare and are sold by private insurance companies, so many plans include other benefits in addition to the same coverage they must provide as Original Medicare. Great news for the Medicare Advantage beneficiaries – some Advantage plans can pay for home care medical services for seniors in need – respite care included.

Medicare Advantage plans may include the following respite care options:

Short-term residential facilities: Many nursing homes, hospice centers and assisted living facilities offer respite care on a short-term basis. Typically, there are rooms in these facilities designed for temporary stays for patients.

Adult day care: Caregivers are able to request respite care via an adult day care on a set schedule or on occasion. This is a good way to give the caregiver the break that is needed while also giving the patient a change of scenery.

In-home respite care: When patients can’t leave their home, this option is great for when the primary caregiver needs a break.

Additionally, Medicare Advantage plans may even include coverage for transportation to and from medical visits for non-emergencies as well as expanded meal and grocery delivery. Depending on the Advantage plan, these services may be restricted to only a certain number of uses per year.

Caregivers deserve breaks from time to time, and seniors deserve to receive care from the comfort of their own home. It’s nice to see our healthcare system recognizes these needs and provides beneficiaries with added benefits for such care. Always consult a professional if you are concerned about what your insurance carrier will cover or won’t cover.