How Many Days Does Medicare Pay for Respite Care?
Learn the specifics of Medicare coverage for hospice respite care, including its duration limits and financial responsibilities.
Respite care offers temporary support for individuals receiving hospice services, providing their primary caregivers with a much-needed break from daily care responsibilities. This specialized care is an important component of the comprehensive hospice benefit available through Medicare. Medicare provides coverage for respite care under specific conditions for eligible beneficiaries.
Medicare Coverage Requirements for Respite Care
For Medicare to cover respite care, the patient must be enrolled in a Medicare-approved hospice program. This enrollment signifies that a physician has certified the patient has a terminal illness with a life expectancy of six months or less, and the patient has chosen comfort care over curative treatments. The purpose of respite care is to provide temporary relief to the primary caregiver.
Inpatient respite care must occur in an approved facility. These facilities include a Medicare-certified inpatient hospice facility, a Medicare-certified hospital, or a skilled nursing facility equipped to provide 24-hour nursing care. Medicare does not cover respite care if the individual does not have an identifiable caregiver, or if they are already residing in a facility that provides 24/7 care, such as an assisted living facility. During a respite stay, the patient receives symptom management and personal care, ensuring their needs continue to be met while the caregiver is away.
Duration of Medicare-Covered Respite Stays
Medicare covers inpatient respite care for up to five consecutive days. This duration is designed to offer a short-term break for caregivers. The day of admission to the facility counts towards these five days, but the day of discharge does not.
These five-day respite stays can be repeated; however, they must occur on an occasional basis. There is no strict limit on how many times this benefit can be used, but an interval, even if brief, must occur between stays for a new five-day period to begin. The hospice team plays a role in determining when respite care is medically necessary and coordinates these stays.
Patient Costs for Respite Care
Patients receiving Medicare-covered inpatient respite care are responsible for a co-payment. This co-payment amounts to 5% of the Medicare-approved amount for inpatient respite care. This daily co-payment cannot exceed the inpatient hospital deductible for that year.
Medicare’s hospice benefit, including respite care, covers services related to the terminal illness. This includes the cost of room and board in the approved facility, nursing care, medications, and medical supplies and equipment. However, Medicare does not cover care for conditions unrelated to the patient’s terminal illness during a respite stay.