Medicare does cover respite care, but only under specific circumstances. It is exclusively a Part A hospice benefit, meaning the patient must be enrolled in hospice care to qualify. For people not in hospice, original Medicare does not cover respite care at all. The coverage is limited to stays of five consecutive days at a time, and you pay 5% of the Medicare-approved amount out of pocket.
Who Qualifies for Covered Respite Care
Because respite care falls under the hospice benefit, the patient must first meet all of Medicare’s hospice eligibility requirements. That means two doctors (the hospice physician and the patient’s regular doctor) must certify a terminal illness with a life expectancy of six months or less. The patient must also agree to receive comfort-focused palliative care rather than curative treatment and sign a statement formally choosing hospice care.
Once a patient is enrolled in hospice, their hospice team decides whether respite care is appropriate. The purpose is straightforward: to give a family caregiver a temporary break. If the hospice team determines the need exists, Medicare covers the patient’s stay in an approved facility while the caregiver rests.
The Five-Day Limit
Federal regulations cap each respite stay at five consecutive days. This is a hard limit. If a patient stays beyond five days, the hospice provider cannot bill those extra days at the respite rate. Instead, the sixth day and any days after it are paid at the routine home care rate, which reimburses at a much lower level and reflects a different type of care entirely.
There is no cap on how many times you can use the five-day respite benefit over the course of hospice enrollment. A caregiver can request respite care repeatedly, as long as each individual stay does not exceed five consecutive days and the hospice team approves each period.
Where Respite Care Can Take Place
Medicare only covers respite care in three types of facilities: a Medicare-certified hospital, a Medicare-approved skilled nursing facility, or a hospice inpatient facility. The hospice program arranges the placement. In-home respite care, where someone comes to the patient’s house so the caregiver can leave, is not covered under original Medicare’s hospice benefit.
What You Pay Out of Pocket
Your cost share for inpatient respite care is 5% of the Medicare-approved amount. This is notably low compared to most Medicare cost-sharing, but there is also a built-in ceiling: your copay for respite care cannot exceed the inpatient hospital deductible for that year. Beyond this small percentage, Medicare covers the rest of the facility stay, including room, board, and nursing care during the respite period.
What Original Medicare Does Not Cover
If someone is not enrolled in hospice, original Medicare (Parts A and B) provides no respite care coverage whatsoever. This is the gap that catches many families off guard. A caregiver looking after a parent with dementia, for example, who is not in hospice, cannot use Medicare to pay for a few days of relief. Part B does not include any respite benefit, and Part A only provides it through the hospice program.
In-home respite services are also excluded even for hospice patients. The benefit specifically requires the patient to be transferred to an approved inpatient facility. If a family prefers to have a caregiver come to the home instead, that arrangement falls outside what original Medicare will pay for.
Medicare Advantage Plans May Offer More
Some Medicare Advantage (Part C) plans include supplemental benefits that go beyond what original Medicare provides. These can include in-home respite care, adult day services, meal delivery, and non-emergency medical transportation. The specific benefits vary widely from plan to plan, so if you’re enrolled in a Medicare Advantage plan, checking your plan’s evidence of coverage document is the most reliable way to find out what respite options are available to you.
This is a meaningful distinction for caregivers whose loved ones are not in hospice. While original Medicare offers nothing in that situation, a Medicare Advantage plan might cover some form of caregiver relief depending on the plan’s supplemental benefit package.
Other Options Outside Medicare
For families who don’t qualify for Medicare’s hospice respite benefit, several other programs may help. Medicaid waiver programs in many states cover respite care for eligible individuals, often including in-home options. The National Family Caregiver Support Program, funded through the Older Americans Act, provides respite services through local Area Agencies on Aging. Some veterans’ benefits also include respite care for eligible veterans and their caregivers. These programs have their own eligibility rules and waiting lists, but they fill a real gap that Medicare leaves open for non-hospice caregivers.