Medicare and respite care in 2019

An unpaid or informal caregiver spends nearly 25 hours a week on average caring for a family member. Roughly 25 percent of the 43 million informal caregivers in America say they work more than 40 hours a week caring for a loved one.

According to the Family Caregiver Alliance, the number of hours spent providing care increases over time. One reason for this is because many caregivers are caring for a spouse or parent. As the care recipient ages, the amount of care he requires grows. Therefore, the job of a caregiver becomes more time consuming each year.

The average age of a care recipient is nearly 70 years old. This means that the majority of care recipients are likely insured by Medicare. Caregivers, possibly even more so than other roles, need a break from time to time so they can care for themselves.

Without some time away from their demanding tasks, caregivers may grow to resent their role. Does Medicare offer respite care coverage for their beneficiaries and caregivers? Let’s find out.

Original Medicare’s Respite Care Coverage

Original Medicare consists of Medicare Part A and Medicare Part B. Medicare Part A includes a hospice care benefit. If your loved one is in hospice care, then respite care is covered.

If there is no Medigap plan to help with out of pocket costs, you pay 5% of the allowable charges for respite care. Caregivers of hospice patients can schedule short-term (up to five days), intermittent respite care when they need it, within reason. 

This care can take place sporadically for as much as a 5-day span each time. Respite care can occur in professional care centers such as hospitals, nursing homes, and in-patient hospice facilities.

New Respite Care Benefits Under Medicare Part C

2019 brought many changes to Medicare. Most of the changes affected Medicare Part C, also known as Medicare Advantage. Each year, the Centers for Medicare and Medicaid Services (CMS) decide what extra benefits Medicare Advantage plans are allowed to offer their beneficiaries on top of what Original Medicare offers.

As of 2019, respite care is a benefit Medicare Advantage plans are allowed to cover. We will see more and more Medicare Advantage plans offering respite care in alternative settings such as adult day care centers, short-term residential communities, and even in-home care.

Respite care costs under Medicare Part C depend on the plan you choose. Medicare Advantage plans set their own pricing for things like copays, deductibles, and coinsurance. To find out if your loved one’s Medicare Advantage plan covers respite care, review their Summary of Benefits.

Alternatives to Respite Care

If your loved one doesn’t have a Medicare Advantage plan that covers respite care and isn’t terminally ill, you may need to look at other options. Sometimes, a friend or family member will step in for you when you need a break.

Your local area may also have an affordable adult day care center you can pay for out-of-pocket. These centers have trained professionals available to take care of your loved one while you are away.