Caregiving for a loved one is an amazing gift—and an awesome responsibility. According to the Family Caregiver Alliance, 34 million Americans have provided unpaid care for a senior family member in the past year. Of those, 96% help with activities of daily living (feeding, bathing, dressing, and toileting) and nearly 50% manage complex nursing tasks such as tube feedings and medication administration.
The economic value of all this family caregiving exceeds $450 billion per year, highlighting the sacrifices of spouses, children, siblings, and other family members make on behalf of their loved ones. It’s no wonder public pressure is steadily increasing to find ways to lower the burden on family caregivers.
Medicare has responded to the outcry on behalf of caregivers, and for the first time, new benefits are available for respite care to help ease the stress on family members. If you’re enrolled in Medicare, here’s what you need to know about these new changes.
How does Medicare cover respite care?
If you have Original Medicare (Part A and Part B), reimbursement for respite care is limited to patients enrolled in hospice care.
If you are terminally ill and elect hospice care instead of treatment to cure your disease, Part A pays 100% of your care, including intermittent, short-term, inpatient hospital respite care. You may be required to pay 5% of the allowable charges in coinsurance depending on the situation.
Unfortunately, that’s the extent of respite care coverage under Original Medicare. If you have a Medicare Advantage plan, however, you may have better coverage.
How does Medicare Advantage cover respite care?
Medicare Advantage plans are private plans. Although they are subject to federal Medicare regulations, they have more flexibility to offer additional benefits to help their members. For example, most Medicare Advantage plans include Part D prescription drug coverage and benefits for routine vision, dental, and hearing care. You lose nothing by switching to Medicare Advantage, but you may gain valuable benefits, including benefits for respite care.
Reimbursement for respite care regardless of diagnosis or care facility is new for the 2019 plan year. The Centers for Medicare and Medicaid Services authorized a slate of new optional benefits for Medicare Advantage plans that relieve the burden on caregivers and encourage aging independently at home. Respite care is one of them.
The new caregiver support benefits include coverage for services such as adult day care, in-home respite care, and short-term respite care in long-term care facilities. Plans may place a limit on the number of hours or days they will reimburse, and they may require you to use a respite care provider that participates with the plan network.
This benefit is available to anyone—you don’t need a terminal diagnosis to qualify for coverage. Best of all, plans can’t charge extra premiums for the new respite care benefit.
Your plan may even offer additional benefits such as coverage for in-home meal delivery, allowances for home safety equipment and devices, and coverage for non-medical transportation via taxi, Uber, or other ride-sharing services to help take the burden off family caregivers.
Depending on your plan, you may have a copayment or coinsurance amount for respite care and other support services. Most plans place an annual cap on these benefits.
Because the law wasn’t changed until October 2018, relatively few plans offered these benefits in 2019, but many more are expected to add them for 2020. If you’re on the fence about choosing Medicare Advantage, these new benefits may help you make a decision. If you are counting on the new respite care benefits, be sure to read plan brochures before you buy, since only a few currently offer them.
Still have questions about Medicare and the changes in respite care benefits? Talk to a Medicare insurance specialist to help you find the right plan to give you maximum support while keeping your costs low.
