Think about when you have a patient, perhaps a parent, who has a chronic or terminal illness. Maybe the loved one has an illness like cancer, or conditions like dementia or Alzheimer’s disease, or any other disability. In this case, you could be the primary caregiver.
Indeed, it’s not a walk in the park. Taking care of such patients can be too overwhelming. It requires a lot of sacrifices, plus an abundance of kindness and compassion. You must be there 24/7, working day and night to offer your beloved the custodial care they need. You might also need to juggle other daily chores while providing the care that your loved one requires.
Even if you’re the sole caregiver to the patient, you must offer all the necessary support to the beloved. But, you also require support for yourself to maintain your sanity. For instance, you should get the breaks you need to breathe away from your everyday caretaking routine. It is at this juncture that respite custody comes in.
Most individuals who require respite care are those that are aged. You’ll mostly find such people already registered for important health insurance like Medicare coverage. Such insurance programs benefit those who are 65 years or older.
Thankfully, Medicare covers respite custody. So, if you are a beneficiary with medicare coverage and are getting continuous care from a loved one, you need to take advantage of respite care. This could be the only best way to thank your caregiver. That way, they also get to enjoy their much-needed break.
As a result, the custodian gets enough strength and morale to care for you best. That’s why our article takes a close look at the facts about whether Medicare covers respite care.
What is Respite Custody, and How Much Does Medicare cover?
Respite care is professional care offered on a short-term basis to older adults. This is done purposely to give their primary care providers time to rest.
If you are a caregiver and offer only a little bit of help to your loved one, let’s say cooking or cleaning only, and you can safely leave them alone, you may not require respite care.
Also, you might not need respite care if you can split tasks with other family members so that you get the much-needed time off.
But, if you are carrying the entire burden alone, where you offer intensive hands-on care to the person, you need respite care. This is essential to avoid instances of caregiver burnout.
So, what’s the extent of respite care with Medicare coverage?
The extent of respite care with Medicare coverage will vary depending on your location and your Medicare or Medicaid eligibility.
Suppose you stay in a state like Texas, and you or your loved one has coverage under Medicare in Texas, you can be eligible for respite custody. Here, immediately after you apply for Medicare in Texas, the system still gets regulated by the federal program and the Centers for Medicare Services (CMS).
How to Apply for Medicare and Benefit from Respite Care
Medicare is federal health insurance offered in the U.S. It’s a program formulated to provide cost-effective healthcare services to those with insurance coverage.
Your eligibility for Medicare in places like Texas and other states in the U.S depends on your age. It will also be based on your disabilities approved by the Social Security Administration (SSA).
In short, you are eligible for Medicare if you qualify for any of the following criteria:
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- You’re 65 years or older.
- You’re below 65, but with social security disabilities consideration.
Expanding Coverage Beyond Original Medicare
Almost everyone eligible for Medicare can enroll in:
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- Original Medicare Part A (hospital insurance)
- Part B (medical insurance)
But, Original Medicare does not cater 100% medical costs. More so, all beneficiaries must have prescription drug coverage. The majority prefer expanding their coverage beyond the Original Medicare (Parts A and B).
Depending on your preference, health needs, and budget, most people get to have:
- Medicare Part C- Medicare Advantage plan
- Medicare Part D- Medicare Supplement and drug coverage
All the above plans are private health insurances regulated and authorized by the Centers for Medicare and Medicaid Services (CMS).
So, those with Medicare in Texas that subscribe to plan C will be liable for Medicare Advantage plans in Texas. And those that seek respite care will be held by the terms and conditions which apply for medicare advantage plans in TX, USA.
What’s Medicare’s Extent of Coverage for Respite Care?
Medicare coverage for most respite care costs will be approved if it forms part of the individual’s hospice care. It is done only occasionally and not beyond five days in a row.
Medicare won’t cover the cost if you need respite care more regularly. So, in this case, the cost of respite will differ based on where you live, the services you request, and the agency you use.
In this case, the Original Medicare Part A caters to respite custody when it forms part of the patient’s hospice care. For the recipient with Medicare Coverage to receive respite care, the patient must meet Medicare’s hospice requirements.
Being eligible for hospice care through Original Medicare Part A entails:
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- Getting certified for terminal illness from a hospice doctor.
- Palliative care acceptance in place with curative care.
- Having a signed statement declaration of the hospice care selection.
Usually, Medicare recipients can receive hospice care from home or other recognized nursing or inpatient facilities. But, Medicare insurance tends to cover only the respite care that occurs in a Medicare-recognized inpatient facility.
Here, the Medicare plan pays for respite care that lasts a maximum of five days in a row. The care is also offered occasionally, but the total stay is not limited to a specific number.
In some instances, recipients may also be liable for 5% of the Medicare-accepted costs for the respite health care.
So, when you decide to use respite care with Medicare coverage, you should check into a Medicare-approved professional care facility like:
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- A hospice
- Hospital
- Care Facility
- Nursing home
Often, the facility will offer an available staff member to give the medicare beneficiary all the needed custodial care.
Key Takeaways
Offering daily care for disabled or ill people with paralyzing conditions like dementia is a significant task. Caregivers will mostly give up their personal matters to keep up with the necessary care of their loved ones.
Nonetheless, caregivers, too, need time to relax and recharge. The best way they can do this is by seeking respite care. It helps both the caregivers and receivers to take advantage of respite care whenever they can. Otherwise, the custodians can easily lose their sanity.
Statistics indicate that 20 to 40% of all caregivers suffer from depression. Women are found to be more prone to caregiver burnout compared to men. In particular, custodians responsible for assisting a person with dementia, Alzheimer’s disease, or other debilitating illnesses risk developing their own health issues.
Indeed, the responsibility of taking care of a person relying on you wholly can blow your mind. It can negatively impact your overall wellness and make you lose your taste for life.
It can also affect the relationship between the caregiver and the loved one under their care. These may lead to the caregiver stress, anxiety, and depression.
Thus, if your loved one is under Medicare’s coverage, you can take advantage by occasionally seeking respite care in Medicare-approved facilities. This will help calm your mind and reduce bouts of stress and anxiety.
