Is There a Copay for Inpatient Respite Care?

Yes — there is a small cost-share for inpatient respite care. Under Medicare, you may owe a coinsurance of 5% of the Medicare-approved amount for the respite stay, which can last up to 5 consecutive days per stay. This is one of only two patient cost-shares in the otherwise no-deductible Medicare hospice benefit.

What inpatient respite care is

Respite care exists to give family caregivers a planned break. The patient is moved temporarily to a Medicare-approved facility (such as a hospice house, hospital, or nursing facility) where the hospice team manages their care, so the family can rest, travel, or simply recover. For the full picture, see what is respite care in hospice.

The two hospice cost-shares

The Medicare hospice benefit has no deductible and covers most services in full. There are just two small charges a patient may face:

• Drug copay — up to $5 per prescription for outpatient medications to manage pain and symptoms.
• Respite coinsurance — 5% of the Medicare-approved amount for each inpatient respite stay.

For how these fit together, read hospice copays and coinsurance under Medicare.

How the 5% coinsurance works

Your share is 5% of the amount Medicare approves for the respite stay. The actual dollar amount depends on the facility's approved rate and the length of stay, so it varies by facility and region — ask your hospice for an estimate before the stay. Because respite is capped at 5 consecutive days per stay, the coinsurance for a single respite episode is typically modest. If the patient also has Medicaid or a supplemental plan, that secondary coverage may pick up the coinsurance for dual-eligibles.

How to estimate your share before the stay

You do not have to guess. The hospice can tell you the Medicare-approved respite rate for the facility it uses, and your coinsurance is simply 5% of that rate multiplied by the number of days. Because no exact figure applies everywhere — rates vary by facility and region — the right move is to ask the hospice for a written estimate for the specific facility and the planned length of stay before the patient is admitted. If you have Medicaid or a Medigap/supplemental plan, ask whether it absorbs the coinsurance so your out-of-pocket cost may be zero. Getting this in writing avoids a surprise bill after a stay you used precisely because you were already stretched thin.

The misconception to correct

Two myths come up here. First, families sometimes believe respite is completely free — it is heavily covered, but the 5% coinsurance is a real, if small, charge. Second, some assume respite covers a long stay; it does not. Respite is short and intermittent, limited to up to 5 consecutive days per stay, and is meant for caregiver relief, not long-term placement. A longer stay for an uncontrolled symptom crisis is a different level called General Inpatient (GIP) care, which has no separate room charge.

Respite vs. other inpatient stays

If you're weighing where a stay would happen, see what an inpatient hospice (hospice house) costs.

How to use respite well

Respite is one of the most under-used parts of the hospice benefit, often because families do not realize it exists or wait until they are already exhausted. A few practical points make it more effective. Use it proactively — schedule a break before burnout sets in, not after. Ask the social worker to build respite into the plan of care so arranging it is routine rather than a scramble. Be aware that respite is intermittent, meaning it can be used more than once over a long hospice stay, with each episode capped at up to 5 consecutive days. And remember its purpose is the caregiver's well-being; taking the break is good caregiving, not a failure. For caregivers showing signs of strain, planned respite can be the difference between sustainable home care and an unplanned crisis.

Where the rest of the hospice benefit has no patient cost

It helps to see the respite coinsurance in context, because nearly everything else in hospice is covered in full. The Medicare Hospice Benefit has no deductible, and for the terminal illness it covers team visits (nurse, aide, social worker, chaplain), comfort medications, medical equipment and supplies, and 24/7 on-call support — with no charge to the patient. The only two cost-shares are the up-to-$5-per-prescription drug copay and the 5% respite coinsurance. Notably, under Routine Home Care at home, Medicare hospice does not pay for room and board, but that is a residence cost, not a hospice charge. So when a respite coinsurance appears on a statement, it is one of just two small, expected charges in an otherwise fully covered benefit — not a sign that something has gone wrong with billing.

Frequently asked questions

Exactly how much will the respite coinsurance be?

There is no single national dollar figure. Your share is 5% of the Medicare-approved amount for the stay, which varies by facility and region. Ask your hospice for a written estimate based on the specific facility and the planned number of days.

Can respite last longer than five days?

A single respite stay is limited to up to 5 consecutive days. If your loved one needs longer facility care because of an uncontrolled symptom crisis, that is a different level — General Inpatient (GIP) care — which is based on medical necessity and has no separate room charge.

Does Medicaid or a supplement cover the 5% coinsurance?

It may. For dual-eligibles, Medicaid often picks up the coinsurance, and many supplemental (Medigap) plans help with cost-sharing. Ask the hospice and your secondary plan whether your out-of-pocket cost would be reduced or eliminated.

How often can we use respite?

Respite is intermittent, so it can be used more than once during a hospice stay, with each episode capped at up to 5 consecutive days. Work with the social worker to schedule breaks proactively rather than waiting for a crisis.

Is room and board free during respite?

During an inpatient respite stay the facility bed is covered by the hospice benefit, with only the 5% coinsurance applying. This differs from Routine Home Care, where Medicare hospice does not cover room and board at all.

Who decides whether a respite stay is appropriate?

The hospice team arranges respite based on the caregiver's need for a break and the patient's stability, documented in the plan of care. You can request it — raising it with the nurse or social worker is the usual first step — and the team coordinates the facility, timing, and an estimate of your coinsurance.

Will choosing respite affect my loved one's other hospice care?

No. Respite is a temporary change in the level of care, not a change in the benefit. When the stay ends, your loved one returns home and Routine Home Care resumes, with the same team and plan of care continuing.

What to do next

• Before a respite stay, ask the hospice for an estimate of your 5% coinsurance in writing.
• If the patient is dual-eligible or has a supplement, ask whether that plan covers the coinsurance.
• Use respite proactively — don't wait for burnout. Ask the social worker to schedule it.
• Choosing a provider? Compare hospices near you and ask which facilities they use for respite.

If you haven't started hospice yet and caregiving feels overwhelming, request a free hospice evaluation — the team can build respite into the plan from the start.