By
Haisey Home Care
Updated on: July 2, 2025
•
x min read
Caring for an aging family member is a rewarding, meaningful role. But it can also be physically and emotionally draining.
Taking care of your loved one every day can become overwhelming after some time. Even helping with daily tasks on a daily basis can quickly lead to exhaustion.
That's where respite care becomes invaluable. It gives carers a much-needed break.
But many families are unsure how to afford this type of aid. Luckily, there are more ways than one to access respite care through government support.
Medicare is one of them, but not in the way you might assume.
If you're wondering, "Does Medicare cover respite care?" this article is for you.
Understanding what is and isn't covered can help you avoid unexpected bills. Most importantly, you'll be able to make informed decisions for your family's well-being.
Understanding Medicare - A Quick Note
To understand the connection between Medicare and respite care, first, you need to know how the former works.
Medicare is Australia's public health insurance system that helps pay for essential medical services.
It usually covers:
- Visits to GPs (general practitioners), fully or partially covered
- Public hospital treatment, as a public patient in a public hospital
- Specialist consultations, with a referral from a GP
- Tests and scans, like X-rays, blood tests, and pathology
- Some surgical procedures, when medically necessary
- Prescription medicines, subsidised under the Pharmaceutical Benefits Scheme (PBS)
- Mental health services (limited sessions with a referral)
- Certain allied health services, like physiotherapy (under specific care plans)
Medicare ensures all Australians have access to basic healthcare, either free or at a lower cost.
For aged care services, Medicare works together with programs like My Aged Care. The goal is to provide subsidised support for older Australians who are eligible.
Is Respite Care Covered by Medicare?
Yes, Medicare does provide coverage for respite care, but not in the way many people expect.
It does not directly pay for all types of respite services like private health insurance might. Instead, respite care is subsidised by the government.
There are certain programs funded under Medicare that can cover respite care. These include:
- The Commonwealth Home Support Programme (CHSP)
- Residential Respite Care
Both of these programs are accessed via My Aged Care.
They allow eligible older Australians to receive temporary care. It may be provided in various settings, from their own home to residential aged care facilities.
Note that this funding is tied to specific programs.
That's why you should understand the conditions, limitations, and application process to access this support.
So the answer is yes - respite care is covered by Medicare mechanisms. But it is not universally available without assessment and planning.
Access depends on individual eligibility and the type of care you need.
Eligibility and Coverage Conditions
Not everyone can automatically receive subsidised respite care.
To access government support, certain eligibility conditions must be met. An assessment process is also required.
Eligibility for respite care under Medicare-funded aged care programs comes with certain conditions. These include:
- The care recipient must undergo an assessment by an Aged Care Assessment Team (ACAT) or Regional Assessment Service (RAS). It depends on the complexity of their care needs.
- The person receiving care must be 65 or older (or 50+ for Aboriginal or Torres Strait Islander Australians).
- There must be an informal carer involved. This can include a spouse, family member, or friend who requires short-term relief from their caregiving duties.
First, eligibility must be established through an ACAT assessment. Then, you will receive a formal referral to access respite care services.
It's important to note that services are not automatically allocated. Availability, location, and provider capacity can affect how and when respite care is delivered.
That's why early planning is key.
Coverage Specifics: Cost, Duration, Frequency
It's important to understand the scope of what is covered. It helps you avoid unexpected out-of-pocket expenses.
Medicare subsidies do significantly reduce the cost burden. But they don't always cover everything.
To add to that, limits on usage and frequency may apply.
What Medicare Covers
Government programs provide financial aid for several types of respite care, including:
- Residential respite care in approved aged care homes for up to 63 days per financial year, with a possible extension of 21 days if medically justified.
- In-home respite care provided through CHSP, covering short-term personal care, home help, and social companionship.
- Emergency and planned respite for carers dealing with unforeseen circumstances or needing scheduled breaks.
These services are designed to be flexible and accessible.
At the same time, they are subject to provider availability. The care recipient's assessment outcome can also impact the coverage.
Expected Costs
Even with subsidies, some costs may still apply. Here's what to be aware of:
- Basic daily fee for residential respite care, usually capped at 85% of the single basic Age Pension.
- Additional fees may apply for special services, transport, or lifestyle activities.
- CHSP contributions are generally modest. They average about $10.85 per day, depending on income and provider policies.
It's essential to request a detailed service agreement or quote from your provider. It will help you understand what is included and which costs may be extra.
Frequency and Duration of Care
While you can use respite care as often as you need, there are limits on what's subsidised:
- Up to 63 days per year for residential respite care, extendable to 84 days with medical approval.
- No fixed annual limit for CHSP respite care or home-based respite care, though the hours are capped by funding availability and service demand.
By knowing these boundaries, families can better plan how to schedule care breaks. They can also apply for additional services if needed.
Types and Settings of Respite Care Covered
Respite care isn't one-size-fits-all.
Fortunately, Medicare-supported respite care is available in a range of settings, allowing flexibility for families.
These include:
- In-home respite care
A support worker comes to your home to provide supervision, personal care, or companionship, allowing the caregiver to rest or leave for appointments.
- Centre-based respite care
Group programs at community facilities that offer social activities and supervision during the day.
- Residential respite care
Temporary stays in an aged care facility are ideal when a carer is away or recovering from illness.
- Emergency respite care
Short-term care that is arranged quickly when a crisis occurs and the carer is unexpectedly unable to provide support.
The right setting depends on your loved one's care needs and your circumstances as a caregiver.
Each of these options has its own access process and funding rules. But, they all require eligibility through My Aged Care.
It's advisable to explore different types in advance to know which setting best suits your situation, and what bookings or notice periods may be required.
Limitations and Alternatives
Medicare does support respite care through its aged care programs. However, the support has limits, both in scope and flexibility.
Not all types of care or frequency of use may be covered. Similarly, not all providers are eligible for subsidies.
These are some common limitations you should consider:
- Not all private respite services are covered, especially if they're not registered with My Aged Care.
- Limited availability in rural areas or during peak periods.
- Waiting lists can delay access, especially for residential care.
- Cost-sharing is often required, which may be burdensome for low-income families.
Alternative Support Options
When Medicare support isn't enough, the following alternatives can help:
- Carer Gateway
Offers emergency respite, peer support, and funding options.
Longer-term funding that can be used to arrange respite care as part of a broader support plan.
- State-based respite schemes
Some states offer extra support for carers in financial hardship or crisis situations.
- Private health insurance
Certain policies include rebates for in-home respite care.
- Community and church-based services
These may offer free or low-cost respite programs on a donation basis.
Frequently Asked Questions
Does Medicare pay for respite care for seniors?
Yes. Seniors who qualify through an ACAT or RAS assessment can access respite care funded through Medicare-supported programs. These include CHSP and residential aged care.
How many days does Medicare pay for respite care?
Medicare subsidies allow up to 63 days per year of residential respite care. This can be extended to 84 days with medical approval.
Is home respite care covered by Medicare?
Yes, under the Commonwealth Home Support Programme. It includes in-home assistance like personal care, social support, and domestic help.
How much does Medicare pay for respite care?
Medicare subsidises a substantial portion, but you may pay a basic daily fee. Additional charges may apply depending on the provider and level of service.
Understanding Your Options
Respite care is not just a luxury. It's a vital tool for sustainable caregiving.
The good news is that respite care is covered under Medicare-supported programs, but there are important limits, rules, and steps involved.
Looking for compassionate, reliable respite care tailored to your family's needs?
Haisey Home Care is here to help.
Our dedicated team offers flexible in-home support that gives carers the break they deserve, without compromising on the quality of care for your loved one.
Contact Haisey Home Care today.
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