By Danielle Kunkle. She is the co-founder of Boomer Benefits,
Source Transition Aging Parents
How does Medicare and Respite Care Works?
Being a full-time caregiver can be both challenging and exhausting. There is so much that goes into being the primary caretaker of someone that is either terminally ill or disabled that many people don’t recognize. It’s a full-time job with very few breaks.
That’s why respite care was designed – to give caregivers a break while providing their loved ones with good quality care in their absence.
What exactly is respite care?
Respite care is the professional care that a primary caregiver will hire to take over their duties in their absence. This form of care can come in many different forms depending on the kind of care needed and the preferred environment. For example, respite care can be provided in an inpatient hospital, a long-term care facility, an adult daycare and even at home.
Trained respite care providers are able to take on managing basic daily functions, administering medications and even tube feedings for those disabled or in need of round-the-clock medical attention. Skilled care by a registered nurse may also be included under respite care for those that are very ill.
These trained providers can be hired on to substitute for a primary caregiver for as little as a few hours to as long as a few days.
Is respite care covered by Medicare?
Medicare Part A covers respite care for beneficiaries who are on hospice and have six months or less to live. Part A pays for up to five days of inpatient respite care at a time, although you may be responsible for a 5% coinsurance amount. If the beneficiary has a Medicare supplement plan, their supplement may pay for this coinsurance.
Take note that you can only use the respite care benefit on an occasional basis.
Does Medicare Advantage cover respite care?
There is good news for caregivers in the new Medicare Advantage guidelines approved by the Centers for Medicare and Medicaid Services (CMS) in October 2018. Respite care is one of the newly allowed supplemental benefits for Medicare Advantage plans.
Benefits that Medicare Advantage carriers may now build into their plans include two items that would benefit caregivers:
· Custodial support in the home: In-home support care is a great option for caregivers that need a temporary break but are in a situation where the patient cannot leave the home.
· Adult day care: Caregivers can schedule respite care through an adult day care on occasion or a set schedule. This is a great change of pace and scenery for the patient while giving the caregiver a temporary break.
Other benefits approved for coverage include non-emergency transportation to and from medical visits and expanded meal delivery. Keep in mind that some of these benefits might be limited to only a certain number of uses a year.
The newly approved respite care benefits is a positive sign that there is an increase in recognition of the need for elder care in the home and caregiver support services. CMS expects a larger number of insurers to offer supplemental benefits in 2020.
