Medicare only pays for respite care for people who are enrolled in Medicare Part A, are eligible for hospice, and who receive respite in a Medicare-certified facility. Medicare won’t pay for respite care that’s provided at home. This guide explains who qualifies, what’s covered, and what to do if Medicare doesn’t meet your family’s respite care needs.
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Original Medicare covers respite care only as part of the Medicare Part A hospice benefit.[01] To qualify, your loved one must be enrolled in Medicare Part A and be eligible for hospice care, which means a physician has certified they have a terminal illness and are expected to live six months or less.
If your loved one is eligible, Medicare may cover short-term respite stays during hospice care when they are medically appropriate. Each respite stay is generally limited to up to five consecutive days.[01]
Original Medicare doesn’t cover respite care that’s provided in your loved one’s home. The Medicare respite benefit is only available to people who qualify for hospice and receive short-term care in a Medicare-certified facility, such as a nursing home or hospice inpatient facility.[01]
Some Medicare Advantage (Part C) plans may offer additional benefits that include professional in-home respite care or adult day care services. Because these benefits vary by plan, contact your loved one’s insurance provider to ask whether respite care is covered, what services are included, and whether any provider restrictions apply.
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Our free tool provides options, advice, and next steps based on your unique situation.
Whether your loved one doesn’t qualify for Medicare’s respite benefit or the benefit doesn’t cover the entire cost, you still have options.
If your loved one doesn’t qualify for Medicare’s respite care benefit, there are other ways to help cover the cost. The best option depends on your loved one’s circumstances, including their health, military service, insurance coverage, and financial situation.
| Your situation | Best place to start | What to do next |
|---|---|---|
| Your loved one may qualify for hospice soon | Medicare (hospice benefit) | Speak with their doctor about hospice eligibility and confirm respite coverage with the hospice provider. |
| Your loved one is not on hospice | Medicaid (if eligible) or private pay | Contact your state Medicaid office to ask about HCBS waivers. If your loved one isn’t eligible, compare the cost of in-home respite care from local providers. |
| Your loved one is a veteran | VA health care | Call the VA’s health benefits hotline at 877-222-8387 to confirm eligibility and ask where respite care is available. |
| Your loved one has long-term care insurance | Long-term care insurance | Review the policy or call the insurer to confirm respite care benefits and any coverage limits. |
| You need respite care right away | Private pay or informal care | Contact local home care agencies for respite care rates or ask family and friends to help temporarily. |
Confirm the respite care benefit with your loved one’s hospice provider, including how many days are covered and where care can be provided. Ask whether you’ll be responsible for any copayments or other out-of-pocket costs so you can estimate what your family may need to contribute. If Medicare’s respite benefit won’t cover all your loved one’s care needs, compare other payment options or plan for additional care after their covered stay ends.
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If your loved one’s care needs have grown beyond what can be safely managed at home, consider residential senior living options, such as assisted living or memory care.
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Yes, Medicare Parts B and D will provide coverage for memory care costs such as medications and treatment planning, but it doesn’t cover room and board costs.
Medicare covers respite care for someone who has dementia only if they qualify for the Medicare hospice benefit. Dementia alone doesn’t qualify someone for coverage. Eligible hospice patients may receive short-term respite care in a Medicare-certified facility
Medicare.gov. Hospice care.
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