How Medicare Covers Respite Care in 2019
Danielle Kunkle <danielle@danielle-medicare.com>
Home Care in Indianapolis IN: Medicare And Respite Care
Caring for someone who is no longer able to live independently is a responsibility that often falls to family members. While there are some blessings and memories to be made with this time, there is no doubt that being a full-time caregiver is also extraordinarily stressful.
Fortunately, Medicare recognizes that caregivers are human and will occasionally need a break to rest and recoup or take a vacation with other loved ones. This time away is vitally important for maintaining the mental and physical strength that is often required to be a primary caregiver. Medicare’s benefits for beneficiaries include some provisions for coverage of respite care. Let’s look at how Medicare will cover respite care in 2019 and beyond.
Defining Respite Care
Respite care is care provided to offer a temporary rest or break to someone who is a primary caregiver. This care includes helping a patient with regular activities of daily living like dressing, bathing or toileting. It may also include transportation to medical appointments, meal preparation or administering prescription medications. Sometimes qualified respite caregivers may also provide skilled care.
For respite care to truly provide relief and peace of mind, the primary caregiver needs to know that their loved one is being cared for well by someone who is qualified to care for them.
Respite care is sometimes provided in the patient’s own home or in an adult day care center. Other times it may be provided in a hospital setting or a long-term care facility. Patients may even find that they look forward to respite care as it gets them out of the house and meeting and interacting with new people.
How Original Medicare Covers Respite Care
Original Medicare is made of up of Part A hospital benefits and Part B outpatient benefits. Part A is responsible for providing hospice care, and respite care falls under this. Medicare Part A will pay for respite care when a beneficiary has qualified for hospice because he or she is not expected to live beyond six months.
To qualify for hospice, the beneficiary must sign a document or statement that testifies that he or she is choosing to be on hospice care rather than continuing to seek treatment to cure a disease or illness.
Part A will pay for up to five consecutive days of respite care for hospice program patients. For the care to be covered, it must occur in a hospital inpatient setting. The beneficiary will have a coinsurance of up to 5% of the cost of the respite care. It’s important to recognize that this is not an ongoing benefit. It can be used occasionally to give the caregiver needed rest.
How Medicare Advantage Plans May Cover Respite Care
Some Medicare beneficiaries elect to get their Part A and B benefits from a private insurance carrier instead of directly from Medicare. They do this by enrolling into a Part C Medicare Advantage Plan.
Medicare Advantage plans must provide all of the same services as Original Medicare. However, they are different from Original Medicare in that they are allowed to include some ancillary benefits like dental, vision and hearing care. For 2019, the Centers for Medicare and Medicaid Services also approved for Medicare Advantage plans to include some new supplemental benefits that fall into the long-term care arena.
These new benefits may include things like home safety modifications and meal delivery. There are also two new allowed benefits that would encompass respite care.
Plans can include coverage for adult day care in a skilled or non-skilled setting. Coverage of this benefit would give a welcome relief to primary caregivers. Each insurance company would be able to set their own limits and rules for how often they offered this benefit. For example, they might set a cap on the number of adult day care visits allowed each year.
Plans can also now include in-home support services, such as custodial care in the home. This would pay for an unskilled custodial care technician to assist the beneficiary with activities of daily living. Plan members should consult their plan’s Summary of Benefits to verify the number of days or hours allowed by the plan for this type of care each year.
Because these supplemental home health benefits were first allowed in 2019, there are only a few hundred plans offering them this year. However, we may find that in 2020 and beyond that many more Medicare Advantage plans begin to use them.
If you or an aging loved-one are considering Home Care in Indianapolis, IN, please call the caring staff at Home Services Unlimited. Serving Greater Indianapolis Area. Call for Immediate Info & Assistance: (317) 471-0760
As a practicing Registered Nurse, Etelka was keenly aware of a void in quality patient care that could be provided in the home. She embarked upon a journey to develop a home health care agency that would exceed all expectations and become a trusted partner to physicians and patients.
A Distinguished Career From Nurse to Director of Nursing to President of Home Services Unlimited
Etelka’s distinguished career followed a logical progression to her position as President of Home Services Unlimited. She graduated as a nurse practitioner with a Bachelor of Nursing (RN) in 1972 from Meshgorya University in the Ukraine, close to where she lived with her family. She married her husband Phil in 1973 and decided in 1977 that they would relocate to the United States to be closer to family and to come to this land of opportunity. With an eagerness to continue her budding career, Etelka sat for and passed her Boards in the U.S. in 1979.
A Love and Talent for Working with the Elderly
Etelka began her nursing career in the U.S. at Colonial Crest, now part of Golden Living, where she was the In-service Coordinator, the Director of Training and Education and Director of Nursing, a position she occupied for several years.
With a group of partners, she co-founded Adept Corporation, which operated group homes for the mentally challenged. The business was successful and in 1996, Etelka sold her share to return to her roots, caring for the elderly.
In January of 1997, Etelka opened Home Services Unlimited as a fully licensed business to provide home health care. In her quest to learn to do better for her patients, she had already obtained a Masters in Healthcare Administration (MHA) in May of 1990 from the College of St. Francis. As President of Home Services Unlimited, Inc., Etelka guides the trusted, experienced care model Home Services Unlimited uses to continue providing excellent home health care.
Giving Back to the Community of Indianapolis
Volunteering for community services is a high priority for Etelka. Her memberships include the Indiana Association of Rehabilitation Facilities, Executive Women in Health Care and the Indiana Association for Home and Hospice Care, where she is a member of the Board of Directors.
Etelka has also served on the Board of Directors with Hooverwood Home, a highly regarded geriatric facility, since 1997 and as the President for 2005-2006. Through her community work, she has received several awards and accolades, including the Nora McFarland award in 2002, from the Indiana Association of Home and Hospice Care.
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