Does Medicare or Medicaid Cover Respite Care?

Does Medicare Cover Respite Care?

Medicare only covers respite care for people who qualify for Medicare hospice care. In essence, this means that if you have Original Medicare Part A, respite care is covered when it is considered to be a part of the recipient’s hospice care. To be eligible for hospice care through Original Medicare Part A, individuals must:

• Receive certification of a terminal illness from a physician or hospice doctor
• Choose palliative care in place of curative care
• Sign a statement declaring the decision to choose hospice care over any other Medicare-covered treatment

Additionally, Medicare insurance covers only hospice care at home or in a Medicare-approved nursing or inpatient hospice facility.1 While Medicare respite coverage can last up to five days at a time, the number of stays is unlimited for seniors who need it, but recipients may be responsible to pay up to 5 percent of the Medicare-approved cost for respite care. Medicare states that these should be “occasional.”

Does Medicaid Cover Respite Care?

Medicaid isn’t as straightforward as Medicare. Individual states administer Medicaid, which is why there is not a single set of rules. Typically, many states offer respite care under Medicaid’s Home & Community-Based Care Services (HCBS) waiver program.2 Depending on where you live, your loved one might qualify for in-home care or care in a designated facility.

To find out whether your loved one qualifies for respite care under Medicaid, look for your state’s profile on the Medicaid HCBS program page and contact your state’s agency directly. Then directly contact your state’s Medicaid agency.

How Else Can I Pay for Respite Care Without Medicare or Medicaid?

If Medicare or Medicaid won’t pay for respite care, don’t give up. There are several other options that may help cover expenses. Each has its own list of covered services, as well as eligibility requirements. Additionally, private pay may be an option, especially if the needed care is relatively simple and you only need it for a short period of time. For a closer look at respite care costs and ways to pay, check out our respite care cost guide.

Consider these alternatives while thinking about your financial coverage options for respite care:

• Long-term care insurance: This private insurance pays for the costs associated with aging or disability. Those who already need respite care likely won’t pass underwriting for a new policy, but if your loved one already has long-term care insurance, respite care may be covered. Every insurer is different, so be sure to call and ask for details about coverage.
• ARCH National Respite Network: Although they don’t provide funding directly, ARCH has compiled information on state coalitions3 that may have access to local respite care funding programs.
• VA benefits: Respite care is a standard part of VA medical benefits, so all enrolled veterans qualify if a determination is made that they need the service. Qualified veterans get 30 days of respite care per year, which may be divided between in-home care of up to six hours in duration (each visit counts as a day of care) and nursing home care for those who need overnight care.
• Private pay: Many people can’t afford to pay out of pocket for extended respite care. However, some adult day care centers and respite care workers charge by the hour or the day. If you need care briefly and sporadically, paying out of pocket may be a reasonable option, especially if medical care is not required.

Where Can I Find Medicaid And Medicare Respite Care Near Me?

Talk to your loved one’s doctor. He or she may work with Medicaid and Medicare regularly and may have some suggestions for local facilities. Alternatively, you can find Medicare providers on the Medicare website or ask your state’s Medicaid department for a list of approved local respite care services.