Medicare comes in two main parts, A and B. Parts A and B are often called Original Medicare, as these have been included since the program first began in 1965. Later, two other parts, named C, or Medicare Advantage, and D, were added. Most benefits, however, come with Original Medicare. These include inpatient and outpatient hospitalizations, preventive care and home health. Part A also includes a hospice benefit for individuals diagnosed with terminal diseases. Respite care is included in Medicare hospice coverage.
Respite Care
Respite care is short-term care provided by a third party so that the usual caregiver, generally a family member, can take some time away. Respite care helps relieve some of the stress on family members while still providing essential services for the hospice patient. The Medicare hospice benefit allows patients to stay in a hospital, nursing home or hospice facility for up to five days at a time for caregiver respite. There was no limit as to the number of times a Medicare beneficiary could claim the hospice respite benefit as of 2011.
Part A
You must be enrolled in Part A or in a Medicare Advantage plan to receive Part A benefits, including respite care. Even if you get your Parts A and B from a Medicare Advantage plan, Original Medicare will still technically handle hospice services. Part B has no benefit for hospice or respite care.
Conditions for Medicare Hospice Coverage
A patient cannot claim the Medicare hospice benefits any time he wants. Medicare requires that certain conditions be met first. A physician must certify that the patient is terminally ill and has less than six months to live. The patient must then sign a statement explicitly choosing hospice care, which is designed to avoid pain and suffering rather than aggressive treatment meant to cure the illness. The patient must also receive all hospice services, including respite care, from providers approved by Medicare.
Costs
As of 2011, Medicare covers 100 percent of most hospice care. The patient pays nothing for services related to hospice. Room and board are not included in the hospice benefits if you live at home or in a nursing home or residential facility. But room and board are covered, although not at 100 percent, if a patient needs to be admitted to a skilled nursing facility or a hospital for respite care. Inpatient respite care requires a coinsurance payment. In 2011, this was 5 percent of the Medicare-approved amount, although the exact coinsurance amount can change.
Tags: respite care, Medicare Advantage, Medicare hospice, Original Medicare, Advantage plan
