Tuesday 30 July 2019


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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