How Often Does Medicare Pay for Respite Care?
Understand Medicare's coverage for respite care, including eligibility, duration, and how often it pays for vital caregiver relief.
Respite care offers temporary relief for primary caregivers, providing them with a much-needed break to rest, attend to personal matters, or simply recharge. Medicare provides specific coverage for respite care under particular circumstances, primarily as part of its comprehensive hospice benefit. This coverage helps ensure that patients continue to receive appropriate care even when their primary caregiver is temporarily unavailable.
Understanding Medicare Respite Care
Medicare defines respite care as short-term inpatient care provided to an individual when necessary to offer relief to their family members or other persons caring for them at home. This specific type of care is covered under Medicare Part A, but only when the patient is receiving hospice services. The primary purpose of this benefit is to give the primary caregiver a temporary break, not to provide long-term care for the patient.
During a respite stay, the patient receives continued care in a Medicare-approved facility. These facilities can include a hospital, an inpatient hospice facility, or a skilled nursing facility. The hospice team ensures that the patient’s medical and personal care needs are met, maintaining the same quality of care they would receive at home.
Eligibility and Coverage Limitations
For Medicare to cover respite care, the patient must first be eligible for and have elected the Medicare hospice benefit. This eligibility requires certification by both the patient’s attending physician and a hospice physician that the patient is terminally ill, with a prognosis of six months or less to live if the illness runs its normal course. The patient must also accept comfort-focused palliative care for their terminal illness rather than curative treatment. A signed statement officially choosing hospice care is also necessary.
Medicare’s coverage for respite care comes with specific limitations regarding its frequency and duration. Respite care is covered for up to five consecutive days at a time, which includes the day of admission but not the day of discharge. While there is no strict limit on how many times respite care can be used, frequent and continuous use, such as repeated five-day stays with only a single day in between, may be viewed as inconsistent with the occasional nature of the benefit.
The care must be provided in a Medicare-approved inpatient facility and is not covered if provided in the patient’s home, an assisted living facility, or a residential care facility. Regarding costs, the patient is generally responsible for a small copayment, typically 5% of the Medicare-approved amount for inpatient respite care. This copayment is capped and cannot exceed the inpatient hospital deductible for the year, which for example, was $1,676 in 2025.
Steps to Access Respite Care
Accessing Medicare-covered respite care begins with communication between the primary caregiver and the patient’s hospice team. The hospice team plays a central role in coordinating and arranging these services. Caregivers should inform the hospice provider about their need for a temporary break and discuss the specific circumstances.
Upon assessing the situation and confirming the need, the hospice provider obtains the necessary physician’s orders and makes arrangements for the patient’s admission to an approved facility. This process ensures that the patient’s care plan continues uninterrupted while they are away from their home. During the respite period, the patient continues to receive all necessary hospice services, including symptom management, personal care, and emotional support.