Medicare and Hospice Respite

What It Is

Inpatient respite care for a hospice patient who's otherwise cared for at home, in order to provide a break for the usual family or other primary caregiver. Respite care can be provided in a hospice facility, nursing facility, or hospital.

What's Covered

Medicare Part A covers up to five days of respite care for a patient who's receiving hospice care. A covered five-day respite care stay may be repeated if hospice staff agrees with the usual caregiver that the further respite is needed.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for respite care in hospice, contact the plan directly.

What Medicare Pays

Medicare Part A pays 95 percent of the Medicare-approved amount for respite care room, board, and care.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

5 Comments So Far. Add Your Wisdom.

8 months ago

ty all for your comments my father inlaw did pass away Tuesday morning at hospice house surrounded by family

8 months ago

Medicare covers five days of respite for the caregiver. If the hospice staff documents the necessity for another five days, then Medicare will cover it. FYI - hospice usually has an M.D. on staff. I suggest that if the M.D. makes the recommendation, then Medicare probably will pay for the additional respite.
 Even when Medicare denies payment, there is always an appeal process that one can do.

8 months ago

Be sure to check with the hospice organization that they are Medicare Certified. As of 2014, Medicare changed providers; this was done to prevent fraud. Now, only Medicare Certified providers are permitted to service Medicare beneficiaries. 
 The hospice program is still generous, but not to the extent to become part of fraud.

8 months ago

I'm just wondering what (or If) I should tell my husband about his stay in respite care. Also if it would be best for me to take him to the facility or allow hospice to make transportation arrangements.

over 2 years ago

Hospice benefits that are covered by Medicare are very generous. To be sure that Medicare covers the care provided, ask the hospice agency first. They will tell you if the care is a Medicare covered benefit.


Want More Medicare Info?

< Browse Other Medicare Topics