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Does Medicare pay for respite care?

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Does Medicare pay for respite care?
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Day Respite
By
November 2, 2020
3
minute read

Will Medicare pay for a stay in respite care?

Respite care provides temporary, short-term care for people who are between carers, or whose carer is unavailable. The need for respite care can arise suddenly, and it's important to promptly find out how it works financially.

Many people assume that respite care in Australia will be covered by Medicare. This is not correct: while there are government subsidies for respite care, they are not paid through the Medicare system.

In this article, we've set out to explain how government subsidies reduce the cost of respite care in Australia, answering questions like:

  • Can you get respite care through Medicare?
  • How does the government subsidise respite care?
  • How does the NDIS work with respect to respite care?

We'll also clear up some confusion that Australians are frequently faced with when researching respite care and Medicare.

At MACG, we are committed to making your life easier, and to providing the best care possible. Find out more about the respite care services we provide.

Does Medicare pay for respite care?

Some medical treatments and services in Australia are covered by Medicare. For example, bulk billing lets people access some kinds of health care at no cost.

Although respite care is subsidised by the Australian government, this is not done through medicare. Rather, the state subsidises the organisations which provide respite care, who then pass that saving on by charging a reduced rate.

How do government subsidies for respite care work in Australia?

Unlike Medicare, which reimburses the patient for medical services, the Australian Government's subsidy for respite care is paid to residential care providers. Additionally, the amount that care providers can charge for respite care is capped.

Care providers receive a subsidy for each person they are looking after in residential respite care. A provider must have ACAT (Aged Care Assessment Team) approval in order to receive the subsidy.

How much will it cost to get respite care?

The Australian Government caps the cost of respite care to recipients. But the cap isn't set at a specific financial figure: rather, the cap is pegged to 85% of the single basic age pension. The amount paid for that pension changes over time, so if you'd like an exact figure for how much a specific stay in residential care would cost, you can contact us to find out more.

When you work with a reputable residential respite care provider like MACG, there shouldn't be any other hidden fees for respite care. No booking fees, accommodation charges, and no bond. You should expect to pay nothing more than a simple daily fee.

Are there limits on how much the government will subsidise respite care?

Yes; because respite care is intended to be temporary, the government will only subsidise respite care for a set number of days per recipient per year.

Most people can expect to qualify for 63 days of subsidised respite care per year. However, some people with special circumstances (for example, those who need an especially high level of care, or who do not have access to a carer) can qualify for an additional 21 days of subsidised care per year.

Does NDIS pay for respite care?

Although Medicare does not pay for respite care, there are other publicly funded programs that might cover the expense. People with a care plan on the National Disability Insurance Scheme (NDIS), for example, may find that a stay in respite care is covered by their NDIS plan.

It is important to note that not every NDIS plan will cover respite care. You can raise the topic of respite care during your NDIS planning meeting, and see if it gets approved in your personalised NDIS plan.

Why does it look as though Medicare covers respite care in Australia?

It can be a bit confusing trying to figure out what medicare will pay for. One reason for this is because, separate from Medicare in Australia, there is a government program in the United States which is also called Medicare. Unlike Australian Medicare, this American Medicare program can cover several consecutive days worth of respite care.

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