Medicare and Hospice Respite
Find out When Medicare Helps Pay for Hospice Respite Care
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.
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.