2022 Medicare Plans Are Changing
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Respite care is professional, short-term care provided to an older adult so their primary caregiver can rest. If you're providing only light assistance to your loved one, such as help with cooking and cleaning, and it's safe to leave them alone, you may not need respite care. Or perhaps you can divide the work with other members of your family so that you all get some much needed time off. But if you're shouldering the burden of providing intensive hands-on support, respite care is essential to preventing caregiver burnout.
So how exactly do you pay for respite care? If your loved one has Medicare or Medicaid, you might wonder whether this type of care is covered. Below we'll take a closer look at Medicare and Medicaid coverage for respite care, along with other ways to pay so that you can take a much-deserved break from caregiving.
Medicare only covers respite care for people who qualify for Medicare hospice care. In this case, Medicare will pay for respite care, along with room and board, in a Medicare-certified inpatient hospice facility.1 The stay may be no longer than five days in a row, and you may be responsible for paying five percent of the cost for inpatient care. More than one stay is allowed, but Medicare states that these should be “occasional.”
To qualify for Medicare hospice care, a hospice doctor and the person's primary doctor (if you have one) must certify that they have a terminal illness and are expected to live no more than six months. In addition, the person must have chosen palliative hospice care rather than treatment for the illness. Medicare does not pay for respite care under any other circumstances.
FYI: Learn more about what Medicare does and doesn't cover, as well as how to enroll, in our complete Medicare guide.
Medicaid isn't as straight-forward as Medicare. Individual states administer Medicaid, so there is no single set of rules. In general, though, 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. Then directly contact your state's Medicaid agency.
If Medicare or Medicaid won't pay for respite care, don't give up. There are several other options that may be able to help. Each has its own list of covered services, as well as eligibility requirements. In addition, private pay may be an option, especially if the needed care is relatively simple and you only need it for a short time. For a closer look at respite care costs and ways to pay, head to our respite care cost guide.
Talk to your loved one's doctor. He or she likely works 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.
Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt
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