Guest Article by Danielle Kunkle Roberts
Family members are usually thrown into the caregiver position. Rarely are adult children and other family members expecting to have to take on the full-time job of caring for another family member. Yet nearly 30% of the United States population has added “caregiver” to their list of daily job titles.
Although caregiving can be a rewarding job, caregivers tend to experience both physical and emotional damages. Because of this, respite care is a much-needed service for full-time caregivers. If you care for a senior or someone who is disabled, you may have to look to Medicare for respite care so you can get the break you need.
How Medicare Covers Respite Care
Original Medicare (Part A and Part B) is how most Medicare beneficiaries choose to get Medicare coverage. If your family member has Part A and Part B as primary insurance, then respite care coverage is limited.
For respite care to be covered under Original Medicare, the beneficiary must be on hospice care. To be on hospice care, the beneficiary’s doctor certifies that the beneficiary has 6 months or less to live. The beneficiary must also sign a document saying they are voluntarily choosing hospice care over treatment.
Part A is in charge of hospice care coverage as well as respite care coverage. If the beneficiary meets these requirements, then Part A covers occasional respite care. There may be a 5% coinsurance for respite care each time it’s used. However, if the beneficiary has a Medigap plan, it usually picks up those out-of-pocket costs.
As the caregiver, you and your family member’s hospice provider will set up respite care in a nursing home, a hospice facility, or a hospital. Respite care coverage can be used multiple times, but only on an occasional basis and for durations of up to 5 consecutive days.
How Medicare Advantage Covers Respite Care
Medicare Advantage is another way beneficiaries get Medicare coverage. Medicare Advantage plans, also called Part C plans, are plans structured more like employer health plans. These plans are sold by private insurance carriers, not Medicare.
When a beneficiary enrolls in a Medicare Advantage plan, the plan covers medical care instead of the government. Medicare requires Medicare Advantage plans to offer coverage at least as good as Original Medicare. However, Medicare Advantage plans are allowed to offer a few extra benefits that Original Medicare doesn’t cover, such as drug, vision, dental, and caregiver services.
Since Medicare Advantage plans differ from company to company, it’s hard to say how each plan covers respite care. Some plans may not offer respite care coverage at all. You and your family member can compare plans to find one that offers caregiver support and enroll in it during the Annual Election Period.
However, if your family member has Original Medicare with a Medigap plan, changing to a Medicare Advantage plan just for the caregiver support may not be the most cost-effective decision.
Options for Respite Care outside of Medicare
If these options don’t work for your family member’s situation, there are other options to consider. The most important factor is to do preliminary research and know what kind of care is available.
Private in-home care agencies, like Golden Heart, provide a safe and comfortable alternative to outside or larger care facilities. By doing researching and speaking with people who have been in a similar situation, you can compare all of your options to make the best decision for you and your loved one.