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Does Medicare Cover Respite Care at Home?
Date Updated: December 9, 2024
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Ashlee Shefer is a freelance copywriter, content writer, and digital marketer who specializes in senior care, mental health, health care, and other wellness-related topics. She has one year of experience writing both short- and long-form content related to senior resources, assisted living, nursing homes, and home care, including blog posts, research-based articles, resource guides, product reviews, facility blurbs, finances, and care costs.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
Medicare doesn't cover respite care at home. However, Medicare Part A covers respite care at a Medicare-approved facility for seniors receiving hospice care. To be eligible, individuals must meet Medicare's hospice requirements and request respite care for no more than five days at a time.
Medicare Eligibility Requirements for Respite Care Explained
Medicare Part A covers respite care under the hospice benefit. Individuals qualify for coverage by meeting certain eligibility requirements, including:
- Having a physician and hospice doctor certify they're terminally ill and have a life expectancy of six months or less
- Accepting comfort care without curative treatment for their illness
- Signing a statement choosing hospice care over other Medicare-approved treatment
While Medicare covers hospice care at home, it only offers coverage for inpatient respite care. This means care must occur in a Medicare-approved facility, such as a nursing home or hospital. Individuals can only request respite care for five days at a time. However, they can access it more than once on an occasional basis. For longer respite care stays, seniors can make additional arrangements through private pay or other insurance options, such as long-term care insurance.
What Respite Care Services Does Medicare Cover?
Under the hospice benefit, Medicare covers a range of respite care services, depending on a person's specific condition and needs. Because Medicare requires individuals to stay at an inpatient facility, it covers room and board, support services to enhance comfort and any necessary medical care as outlined in the patient's hospice care plan. Specific services can include:
- Assistance with daily living activities, including dressing, bathing or mobility
- Skilled nursing services, such as wound care or medical equipment maintenance
- Physician services
- Medical supplies, such as catheters or bandages
- Pain and symptom management
- Rehabilitative therapies
- Daily meals
- Dietary or nutrition support
- Use of facility amenities
Depending on their Medicare plan, individuals may pay 5% of the approved amount for inpatient respite care. However, Medicare doesn't allow co-pays to exceed a person's annual inpatient hospital deductible.