Medicare Respite Care Limit

Hospice care, generally given in the home, provides care and support to the terminally ill. Usually one person is assigned to the dying within the home. When the daily caregiver needs a break, respite care from another caregiver fills the gap. Medicare covers respite care within certain limits.

Respite Care

• To receive Medicare-paid respite care, you must go to a Medicare-approved facility, such as a hospice facility, hospital or nursing home. You can stay in the facility for up to five days each time you receive respite care. Medicare has no limit to the number of times you can receive respite care.

Payment

• You are responsible for paying 5 percent of the Medicare payment amount for inpatient care, that is, $5 out of every $100. Your financial responsibility can change each year. Medicare directly pays the hospice provider the remaining 95 percent.

Hospice Benefit Eligibility

• Medicare pays for hospice care as long as certain conditions are met, including eligibility for Medicare part A; a doctor and hospice medical director certify the patient is terminally ill and has six months or less to live if the illness follows its normal course; patient authorization for hospice care in place of other Medicare-covered treatments; and treatment provided by a Medicare-approved hospice program.

Considerations

• Medicare covers respite care even if your primary caregiver is a family member, as long as the patient is enrolled in a Medicare-approved hospice program.