Can Medicare cover respite care?
Getting respite care can be very helpful and critical for some people. Not just for those that require the care itself, but those who are the usual carer and absolutely need a break from the everyday demands and stress.
Whilst everybody wants to be able to continue caring for their loved ones, sometimes you need to take a step back for the sake of your own mental health and physical health.
Medicare offers a lot of things, but you may be questioning if it covers respite care at all. Luckily, we’ve looked into this for you.
This guide will look at what Medicare is, what respite care is and if Medicare can cover the costs of the service or not.
Read on to learn more.
Table of contents
What is Medicare?
Medicare is a federal run insurance program that looks to provide health service coverage for certain people that qualify.
These groups are normally those over the age of 65, those with specific disabilities or those who are living with permanent kidney damage which requires regular dialysis services.
Whilst Medicare can take care of some of the costs associated when it comes to healthcare, it cannot take care of everything.
It is critical that we understand this because many people will be shocked or hit with an unexpected bill that they may struggle to pay.
There are three elements of Medicare which include plan A, plan B and plan D. Each element can be thought of as a “type” of insurance.
Plan A for example can be thought of as hospital insurance which covers some of the costs with things such as inpatient hospital care, time at a skilled facility of nurses, general health care and hospice care.
The second one, Plan B, can be considered as medical insurance which covers some of the costs with things such as doctors’ services, doctors’ appointments, some outpatient services and care, medical equipment, home health care and preventative services.
The last one, Plan D, is a little more tricky as it is run by a private insurance company, however you can consider it as medicine insurance.
This may cover some of the costs involved with medicine such as pills or vaccinations.
Plan A is typically completely covered for those who are eligible. In other words, costs associated with Plan A treatments require no payments towards their service.
Normally, these eligible people are people aged 65 or over, but there may be exceptions so be sure you clarify this.
Part B on the other hand will normally require a monthly paid premium to receive some of their services.
Why is There No Plan C?
As we mentioned, some elements of Medicare are handled by private insurance companies, like part D.
Part C is now named the Medicare Advantage Plan. This includes everything that part A and B have but will also include extra services such as vision and hearing services.
What is Respite Care?
Respite care refers to a “substitute” carer who takes over the care of whomever the original primary caregiver is.
As being a care provider is one of the most demanding, difficult and stressful jobs you can possibly do, getting a break now and again (known as respite) is critical.
Respite care can take place in several different places. This could be within your own home, in a residential care facility, day care centers or overnight care centers.
These are categorized into two. One is in-home respite care and the other is out-of-home respite care.
In-Home Respite Care
In-home respite care refers to the care that is provided by either volunteers or paid caregivers.
This type of care is popular with people. Because it can normally allow your family member or friend to remain in their own home.
Care provided may be many things. Like managing their everyday tasks such as bathing, cooking, and cleaning. But can also include providing their required medication, shopping, feeding, and other financial management.
Out-Of-Home Respite Care
Out-of-home respite care refers to the care that is provided away from the usual home environment.
These are things such as adult day care centers, residential programs or respite camps. All of these have slight differences.
Adult day care centers are places that can provide care for the person. But only throughout the daytime, depending on their operating hours.
This can be okay, but sometimes it is not feasible for some carers.
Residential programs are around the clock programs in large centers that take care of the person with their high quality nursing services.
Respite camps are similar to this but they are not intended for long term care. They may be slightly different in the way they offer their services.
Will Medicare Cover Respite Care Costs Though?
This can get a little confusing. But from what we know based on the information above and from Medicare themselves, we can clarify this slightly.
Medicare will usually cover most costs through plans A and B to alleviate the costs associated with hospice care. However, this must take place in a place that is approved by Medicare.
Will I Need to Pay Anything?
You may need to pay five per cent of the costs of Medicare if you only have original Medicare which is Part A and B.
If you pay for the extra services through Medicare Advantage Plan (formally Part C), you may have help with the out-of-pocket costs.
Be sure to check with Medicare for specifics and speak with your doctor too.
Medicare normally covers five days worth of this respite care at any time, you can receive this more than once if you need assistance in a hospice. However, Medicare only usually allows this on an occasional basis.
The Bottom Line
Medicare does cover respite care but it will largely depend on what type of plans you have and personal circumstances. Be sure to clarify this before asking for services.
Frequently Asked Questions
An example of short- term care is where you are placed in a care home to receive respite care, possibly on a regular basis. and it is unlikely to exceed 52 weeks. It can exceed this period in exceptional circumstances, if it is unlikely to ‘substantially’ exceed 52 weeks.
In-home care is to help the person who requires care, while respite care is to provide assistance and relief to a primary caregiver. If you’ve been a primary caregiver and are looking to go back to work or transition into part-time caregiving, then you should talk to a representative about in-home care.
Most people who receive this type of care do so for around 1 or 2 weeks, although you get free, short-term care for a maximum of 6 weeks. It will depend on how soon you are able to cope at home. If you need care for longer than 6 weeks, you may have to pay for it.