Does Medicare Pay for Respite Care?
If you’re receiving hospice care, Original Medicare and Medicare Advantage will cover up to 5 consecutive days of inpatient respite care in a hospital or skilled nursing facility.
Respite care can offer short-term relief for primary caregivers. Although respite care can last anywhere from a few hours to several weeks, Medicare will only cover up to 5 days at a time.
You may be eligible for more than one occurrence of respite care per benefit period. Medicare does not provide firm guidance on how many covered periods of respite care are allowed per calendar year or benefit period.
Eligibility
Medicare does not provide a predetermined list of scenarios that would qualify for respite care. However, it’s generally understood that your primary caregiver may need respite:
in times of illness or extreme exhaustion
to attend a family event
to go on vacation
Respite care can only be provided at a Medicare-certified inpatient hospice facility or, if appropriate, a hospital or a skilled nursing facility that can provide 24-hour care.
Medicare does not cover respite care in an assisted living facility, residential care facility, or private residence.
Your hospice care team must coordinate your respite care. Medicare does not cover respite care arranged outside of your hospice care team.
Original Medicare coverage and costs
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Respite care is covered under Part A.
Most people do not have to pay a monthly premium for Part A. If you don’t meet the criteria for premium-free Part A, you’ll pay $278 or $505 each month.
You’re responsible for 5% of all Medicare-approved costs for inpatient respite care. This is called a coinsurance.
However, the total coinsurance cost may not exceed the inpatient hospital deductible — $1,632 in 2024 — for the calendar year.
Supplemental Medicare insurance (Medigap) can help cover some of the out-of-pocket costs associated with Original Medicare. This includes Part A premiums, deductibles, copayments, and coinsurance costs.
Medicare Advantage coverage and costs
Medicare Advantage, or Part C, plans must cover the same basic services as Original Medicare, including inpatient respite care.
Some Part C plans also cover:
adult day health services
in-home support services
caregiver support services
Each Part C plan sets its own cost and coverage amounts. Your individual plan will determine whether you have a premium and, if so, how much.
The deductibles, copayments, and coinsurance amounts you’ll pay also depend on your chosen plan.
Staying in network — which means getting care from a list of approved healthcare professionals and facilities — usually costs less than going out of network.
Respite care isn’t a standard Medicaid benefit. However, many states participate in Medicare’s Home and Community-Based Care Services (HCBS) waiver program to offer a full or partial respite care coverage.
You can contact your local Medicaid office to learn more.
The bottom line
Original Medicare and Medicare Advantage will cover 95% of the costs of respite care for up to 5 consecutive days. You’re responsible for the remaining 5% in addition to your plan’s monthly premium.
If you have Original Medicare, Medigap can help cover these out-of-pocket costs. Medigap is not available for Medicare Advantage beneficiaries.
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