This post features a guest blogger, Danielle K. Roberts, a Medicare expert and regular writer for online publications. You can learn more about her work at www.daniellekroberts.com.
According to the National Alliance for Caregiving (NAC), there are over 40 million unpaid caregivers in the United States. Of that 40-plus million, nearly 80% care for a senior who likely has Medicare.
For all the caregivers do, it’s astonishing that most are unpaid. According to the AARP Public Policy Institute, unpaid caregivers had a value of $470 billion in 2013 alone.
The average caregiver cares for a loved one for 4 years, according to the NAC. However, nearly 40% of caregivers provide care for more than 5 years.
Although caring for a loved one can be very rewarding, it can also cause a lot of stress, especially for unpaid caregivers who rarely take time off. Thankfully, Medicare has slightly upped its game in the respite care field.
What is respite careMedicare defines respite care as “temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a caregiver can rest or take some time off.” In short, respite care is a caregiver’s vacation.
When Original Medicare Covers Respite CareOriginal Medicare consists of two parts, Part A and Part B. Part A is your in-patient hospital stay benefits, while Part B is your outpatient benefits. Part A covers respite care for its beneficiaries’ caregivers if the beneficiary is officially on hospice care.
To be on hospice care, the beneficiary must be certified as terminally ill with less than 6 months to live, accept care solely for comfort, and sign an official document stating he or she is choosing hospice care over trying to cure illness.
Once hospice care has started, caregivers can request respite care whenever they need time away. Part A allows up to 5 consecutive days of respite care at a time, and only on an occasional basis. The beneficiary can get respite care in the hospital, in a hospice facility, or in a nursing home.
If the beneficiary doesn’t have a Medigap plan that covers the Part A coinsurance, then there may be a 5% coinsurance charge for each respite care stay. Many Medigap plans cover the Part A hospice coinsurance.
When Part C covers respite careMedicare Part C, also known as Medicare Advantage, is a part of Medicare that combines your Part A, Part B, and usually, Part D benefits into one plan. These plans are sold by private insurance carriers, such as United Healthcare, Cigna, and Aetna.
Part C plans are required to offer the same benefits as Original Medicare at a minimum. However, that doesn’t mean they can’t offer better coverage. Also, the Centers for Medicare and Medicaid Services (CMS) allow Part C plans to offer a few additional benefits that Original Medicare doesn’t offer.
For example, Original Medicare doesn’t cover respite care unless the beneficiary is on hospice care. As of 2019, Medicare Advantage plans are allowed to offer respite care under their own rules. Your loved one may be able to get respite care without being under hospice care.
Each Medicare Advantage plan has its own set of rules and pricing for services. Because of this, you need to read plan brochures carefully to see what’s covered. If your loved one wants a Medicare Advantage plan offering respite care coverage, compare plans in your area prior to the Annual Election Period that runs from October 15th until December 7th.
Alternatively, you can look into short term respite care at facilities such as adult daycares, nursing homes, and in-home care. You may have to pay for these services yourself, but check with your local Area Agency on Aging to see if help is available.
For all the caregivers do, it’s astonishing that most are unpaid. According to the AARP Public Policy Institute, unpaid caregivers had a value of $470 billion in 2013 alone.
The average caregiver cares for a loved one for 4 years, according to the NAC. However, nearly 40% of caregivers provide care for more than 5 years.
Although caring for a loved one can be very rewarding, it can also cause a lot of stress, especially for unpaid caregivers who rarely take time off. Thankfully, Medicare has slightly upped its game in the respite care field.
What is respite careMedicare defines respite care as “temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a caregiver can rest or take some time off.” In short, respite care is a caregiver’s vacation.
When Original Medicare Covers Respite CareOriginal Medicare consists of two parts, Part A and Part B. Part A is your in-patient hospital stay benefits, while Part B is your outpatient benefits. Part A covers respite care for its beneficiaries’ caregivers if the beneficiary is officially on hospice care.
To be on hospice care, the beneficiary must be certified as terminally ill with less than 6 months to live, accept care solely for comfort, and sign an official document stating he or she is choosing hospice care over trying to cure illness.
Once hospice care has started, caregivers can request respite care whenever they need time away. Part A allows up to 5 consecutive days of respite care at a time, and only on an occasional basis. The beneficiary can get respite care in the hospital, in a hospice facility, or in a nursing home.
If the beneficiary doesn’t have a Medigap plan that covers the Part A coinsurance, then there may be a 5% coinsurance charge for each respite care stay. Many Medigap plans cover the Part A hospice coinsurance.
When Part C covers respite careMedicare Part C, also known as Medicare Advantage, is a part of Medicare that combines your Part A, Part B, and usually, Part D benefits into one plan. These plans are sold by private insurance carriers, such as United Healthcare, Cigna, and Aetna.
Part C plans are required to offer the same benefits as Original Medicare at a minimum. However, that doesn’t mean they can’t offer better coverage. Also, the Centers for Medicare and Medicaid Services (CMS) allow Part C plans to offer a few additional benefits that Original Medicare doesn’t offer.
For example, Original Medicare doesn’t cover respite care unless the beneficiary is on hospice care. As of 2019, Medicare Advantage plans are allowed to offer respite care under their own rules. Your loved one may be able to get respite care without being under hospice care.
Each Medicare Advantage plan has its own set of rules and pricing for services. Because of this, you need to read plan brochures carefully to see what’s covered. If your loved one wants a Medicare Advantage plan offering respite care coverage, compare plans in your area prior to the Annual Election Period that runs from October 15th until December 7th.
Alternatively, you can look into short term respite care at facilities such as adult daycares, nursing homes, and in-home care. You may have to pay for these services yourself, but check with your local Area Agency on Aging to see if help is available.
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