Medicare Provides Few Respite Coverage Options for Caregivers
Coverage for caregivers to take a breather from caring for a loved one at home is spotty. In general, traditional Medicare only pays for respite care if a patient has entered hospice. To be eligible, the doctor has to certify that the patient is terminally ill and expected to live for six months or less. The program pays for the Medicare beneficiary to be moved to a hospital or nursing home for up to five days at a time so the caregiver can get some rest. Some Medicare Advantage special needs plans may cover respite care, but there’s no requirement that they do so, says Elaine Wong Eakin, Executive Director of California Health Advocates, a Medicare advocacy group. Special needs plans are Medicare Advantage managed care plans that limit membership to certain types of beneficiaries and tailor services to their needs. Some only accept people who have certain diseases, such as dementia or heart failure. Others only sign up people who are eligible for both Medicare and Medicaid, the federal-state health program for low-income people. Still others accept only beneficiaries who are institutionalized and need nursing home care. Eakin advises checking with your State Health Insurance Assistance Program to find Medicare Advantage special needs plans or other community services that might meet your needs.
David Wingate is an elder law attorney at the Elder Law Office of David Wingate, LLC. The elder law office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick and Montgomery Counties, Maryland.