Medicare covers respite care only in specific situations, and the coverage is limited
Medicare does pay for some respite care, but not all types and not in all settings. The coverage depends on whether you are in a Medicare-covered hospice program, whether you need skilled nursing care, and where that care takes place. If you are looking for someone to stay with a family member so you can take a break, Medicare's coverage is narrow — it covers respite care mainly when it is part of a hospice benefit or when it is tied to a hospital stay.
The most common way Medicare covers respite care is through hospice respite care. If you are enrolled in a Medicare hospice benefit, Medicare will pay for up to five consecutive days of inpatient respite care in a hospital or nursing facility each time you need a break from home care. This means the hospice patient stays in a facility while the family caregiver rests, and Medicare covers the cost. Outside of hospice, Medicare's respite care coverage is much more limited and usually only available through skilled nursing facility (SNF) care following a hospital stay.
Key Takeaways
- Medicare covers respite care as part of a hospice benefit for up to five consecutive days at a time in a hospital or nursing facility.
- Outside of hospice, Medicare does not cover respite care arranged straightforward to give a caregiver a break.
- Some skilled nursing facilities may provide short respite stays after a hospital discharge, but this is not a may provide Medicare benefit and depends on the facility and your medical need.
- Medicaid, Veterans benefits, and local Area Agencies on Aging often cover respite care when Medicare does not.
- Many private insurance plans and long-term care insurance policies include respite care coverage as part of their benefits.
How hospice respite care works under Medicare
If you are enrolled in a Medicare hospice program, respite care is a built-in benefit. Medicare will pay for a hospice patient to stay in a hospital or nursing facility for up to five consecutive days so that the family caregiver can rest. You do not have to pay anything out of pocket for these five days — Medicare covers the full cost. The hospice agency arranges the respite stay, and the patient receives the same hospice services (pain management, comfort care, spiritual support) in the facility that they would receive at home.
You can use respite care more than once. If you need another break after the first five days, you can arrange another respite stay, and Medicare will cover it the same way. There is no limit to how many times you can use this benefit during your hospice enrollment. The only requirement is that the respite care must be provided by a Medicare-certified hospice agency or in a facility that works with your hospice provider.
Respite care outside of hospice: what Medicare does and does not cover
Outside of hospice, Medicare does not cover respite care arranged straightforward to give a family caregiver a break. If you need someone to stay with an older adult at home while you take time off, Medicare will not pay for that service. Medicare also does not cover adult day care, companion care, or homemaker services — all common forms of respite care that families use.
The only exception is if respite care is part of a skilled nursing facility stay that follows a hospital admission. After a three-day hospital stay, Medicare Part A may cover up to 100 days in a skilled nursing facility. During that stay, the facility may provide what looks like respite care — the patient is in the facility receiving care while family members are not providing hands-on support. However, this is not respite care in the traditional sense; it is skilled nursing care, and Medicare covers it only because the patient needs skilled services like wound care, physical therapy, or medication management.
What you may have to pay for respite care
If you are in a hospice program and use the Medicare respite care benefit, you pay nothing. Medicare covers the full cost of the five-day respite stay.
If you need respite care outside of hospice and Medicare does not cover it, you will need to pay out of pocket or look for coverage through another source. The cost of respite care varies widely depending on where it is provided. In-home respite care (hiring someone to stay with a family member) can range from $15 to $30 per hour or more, depending on your location and the type of care needed. Adult day programs typically cost $50 to $150 per day. Facility-based respite care (a short stay in a nursing home or assisted living facility) can cost $100 to $300 per day or more.
Medicaid and other programs that may cover respite care
Medicaid covers respite care in many states, though the rules vary. Some states cover in-home respite care, while others cover facility-based respite only. If you are on Medicaid, contact your state Medicaid office to ask what respite services are covered in your state.
If you are a veteran or the spouse of a veteran, the Department of Veterans Affairs may cover respite care through its Aid and Attendance benefit or other programs. Contact your local VA office or call 1-800-827-1000 to learn what is available to you.
Area Agencies on Aging (AAA) can tell you about respite care programs in your community. Some are free or low-cost, funded by the Older Americans Act. Call the Eldercare Locator at 1-800-677-1116 to find your local AAA, or visit eldercare.acl.gov.
Long-term care insurance policies often include respite care as a covered benefit. If you have a long-term care policy, check your policy documents or call your insurance company to see what respite services are covered and how much you can use per year.
How to arrange respite care through Medicare hospice
If you are already enrolled in a Medicare hospice program, contact your hospice agency and tell them you need respite care. The hospice team will work with you to find a hospital or nursing facility that can provide the respite stay and will handle the arrangements. You do not need to do anything else — the hospice agency manages the process.
If you are not yet in hospice but think you might be, talk to your doctor. Your doctor can refer you to a hospice agency if you have a terminal illness and a life expectancy of six months or less. Once you are enrolled, respite care becomes available to you.
Planning ahead for respite care needs
If you are a family caregiver and know you will need breaks, start planning now. If the person you care for has a terminal illness, hospice enrollment gives you access to respite care through Medicare. If they do not, look into Medicaid coverage in your state, ask your Area Agency on Aging about local programs, and consider whether long-term care insurance or Veterans benefits might help.
Many caregivers wait until they are exhausted to look for respite care, which makes the process harder. Reaching out early gives you time to understand your options and set up a plan that works for your situation. Caregiver burnout is real, and respite care — whether covered by Medicare or another source — is an important part of taking care of yourself while you care for someone else.
Frequently Asked Questions
Does Medicare cover respite care if I am not in hospice?
No. Outside of hospice, Medicare does not cover respite care arranged to give a caregiver a break. The only partial exception is skilled nursing facility care after a hospital stay, but that is skilled care, not respite care. You would need to look at Medicaid, Veterans benefits, or local programs for coverage.
How much does the five-day hospice respite stay cost?
Nothing. If you are enrolled in a Medicare hospice program, Medicare covers the full cost of respite care for up to five consecutive days. You do not pay a copay, coinsurance, or deductible for this benefit.
Can I use hospice respite care more than once?
Yes. You can use the five-day respite benefit as many times as you need during your hospice enrollment. There is no limit to how many respite stays you can have. Each time, Medicare covers the full cost.
What if my state Medicaid does not cover respite care?
Contact your Area Agency on Aging to ask about free or low-cost respite programs in your community. Some are funded through the Older Americans Act. You can also ask your doctor or social worker about programs offered by local nonprofits or senior centers.
Does long-term care insurance cover respite care?
Many long-term care policies do include respite care, but coverage varies by policy. Check your policy documents or call your insurance company to see what respite services are covered, how much you can use per year, and whether there are any limits on where care can be provided.