I am delighted to host this very informative guest post by guest expert, Danielle K. Roberts about recent changes to respite benefits in US Medicare.
According to the National Alliance
for Caregiving, there are nearly 35 million caregivers caring for a loved one who
is over the age of 50 in the United States today. Providing a family member in need with support and care
is truly a rewarding job. However, family caregivers usually work year-round
and usually for free.
That’s why being able to access
temporary care for your loved one so you can take a much needed and deserved
break is important. Respite care is just the way to do that.
Original
Medicare only covers respite care for its beneficiaries under one
circumstance that we will discuss below. But don’t worry, you may have other
options if your loved one doesn’t meet Original Medicare’s requirements.
Respite
Care Under Original Medicare
Original Medicare consists of Part A
and Part B. Part A covers things such as hospitalizations, skilled nursing
facility stays after a hospitalization, and hospice care. If the patient is
put on hospice care, then Medicare Part A will cover 100% of their costs.
To be put on hospice care, the
patient must:
● Be declared terminally ill with
less than six months to live by your hospice doctor.
● Accept to receive care to keep
you comfortable rather than care to try and cure your disease or illness.
●
Sign
a notice stating you are electing hospice care over treatment for your disease
or illness.
Once the patient meets the above
requirements, he qualifies for respite care under Original Medicare Part A.
Part A will cover up to five days of
respite care each time the patient needs it. You can set up respite care with
your loved one’s doctor multiple times, but on an occasional basis. The
respite care can be provided in the hospital, a nursing home, or a hospice
inpatient facility.
When a patient receives respite care
under Part A, there may be a 5% coinsurance. However, if they have a
Medigap plan, then that coinsurance is covered at 100%.
Respite
Care Under Medicare Part C
Medicare Part C, most commonly known
as Medicare Advantage, is an optional type of plan Medicare beneficiaries can
enroll in. Medicare Advantage is offered by private insurance companies; when
you choose Medicare Advantage, you get your health coverage through the
insurer, not through Medicare.
The carriers who sell the plans set
the plans’ premiums, deductibles, coinsurance, coverage guidelines, doctor
networks, and more. However, each Medicare Advantage plan is required to
provide the same benefits as Original Medicare, at a minimum, although many
include extra benefits.
A few great benefits of having a
Medicare Advantage plan are having a maximum allowed out-of-pocket, included
drug benefits, and ancillary benefits that Original Medicare doesn’t cover
such as dental and vision.
As of 2019, private insurance
carriers are allowed to offer respite care benefits to their Medicare
Advantage plans. Only a small number of Medicare Advantage plans currently
offer this benefit. However, the rule was rolled out after many insurers
already rolled out their plans for 2019, so it’s expected that many more will
offer these extra benefits in the coming years.
Just like other benefits, the
carriers set the prices and guidelines for respite care coverage. Therefore,
one plan may cover respite care with few restrictions, while another carrier
may require you to use a specific provider, for example.
Medicare beneficiaries can enroll in
or change their Medicare Advantage plans every year during the Annual Election
Period (AEP). The AEP runs from October 15th to December 7th.
When the AEP gets close, you and your loved one can evaluate plans in their
area to see if any of them offer respite care coverage.
Other Options for Respite Care
If your loved one isn’t on hospice
care or doesn’t have a Medicare Advantage plan, there are a few other routes
you can take for respite care. Without coverage, these routes may be a little
expensive.
You can look into respite care
facilities, adult day-care facilities, and in-home health aids. If you have
all options available in your area, determine which is the most cost-effective
and convenient for you.
Danielle K Roberts is the co-founder of Boomer Benefits where she and her team
help baby boomers navigate their Medicare insurance options. She is a member of
the Forbes Finance Council and writes frequently about Medicare, retirement and
personal finance.
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