Respite care (short-term care for an individual so that the usual caregiver may have some time off) can be a tremendous boon for overworked or stressed family caregivers. Of course, finding a way to make respite care financially feasible can sometimes be a challenge. In an ideal scenario, family members or friends step in to take over caregiving duties without seeking compensation; however, many caregivers need to pay someone to provide short-term care. Does Medicare cover any of the costs of such care? The answer is yes, but only if the patient is in hospice.
What is hospice care?
Hospice care is care that is given to terminally ill patients, and is focused on providing comfort and sustenance without thought of providing a cure. In such cases doctors no longer treat diseases, but instead alleviate symptoms and pain as much as possible. For Medicare to cover hospice-related expenses, a patient’s doctor must provide certification that he or she expects the patient to live only for six months or less. Patients who live longer than six months can continue to be covered for hospice expenses provided that the doctor re-certifies them as terminally ill every six months.
What respite care expenses does Medicare cover?
If a patient is certified as receiving hospice care, the patient can be placed in respite care for a short time and Medicare will cover a portion of the costs. In general, the Medicare-covered patient is responsible for paying 5% of the Medicare-approved cost associated with the respite care; typically that 5% comes out to $5 to $12 per day. It’s important to note that this 5% refers to the Medicare-approved cost. For example, if Medicare determines that the respite care services an individual is requesting should cost $100 per day, it will pay $95 per day. If the facility actually charges $100 per day, the individual will pay $5; however, if the facility charges $150 per day and Medicare values its care at only $100, then the individual is responsible for paying the difference. In this case, the individual would pay $55 per day. Respite care must also be given in a Medicare-approved facility, and the length of the respite care cannot exceed five consecutive days; however, an individual can receive respite care more than once.