July 16th 2024
By Ari Parker
Discover if Medicare covers adult day care services and explore alternative options for financing this essential care for your loved ones.
Adult day care facilities provide valuable services to older adults who need more attentive assistance or supervision throughout the day. They’re great resources for families who want to make sure their loved ones are in a safe environment while balancing their own responsibilities.
Unfortunately, Medicare doesn’t cover adult day care. If you’re eligible for Medicaid, you may be eligible for adult day care coverage. Individual states vary with their Medicaid coverage rules, so make sure to check your state’s criteria.
Medicare doesn’t cover adult day care services.
Some programs, like Medicaid and VA benefits may cover the service.
Medicare Advantage may cover caregiver services and adult day care, but benefits vary significantly between plans. Check your summary of benefits to see if your Medicare Advantage plan covers adult day care.
Caregivers often consider adult day care centers for an older family member who needs care, companionship, medical attention, and/or supervision during the day. These facilities provide opportunities for social interaction, personal care services, and meals and snacks. Some adult day care centers also offer health-related services, like medication management and chronic condition monitoring.
Many people who need adult day care services have chronic conditions, including Alzheimer’s or other dementias. In these cases, it can be helpful for families to have extra support when caring for their loved ones.
The cost of adult day care can vary by state and the number of service hours you need. On average, families spend $2,058 per month on adult day care in the US. Long-term care can be quite expensive. Consider whether long-term care insurance is worth it for you.
Medicare doesn’t cover adult day care or any services from a care facility for a long period or for non-medical purposes. It also doesn’t cover assisted living residences or round-the-clock home health aides. Finally, Medicare rarely pays for custodial care (like grooming, bathing, and dressing) if it’s the only care that you need.
Medicare does cover the following services for a short period:
Skilled nursing care at home or at a facility
Some Medicare Advantage plans include additional benefits, like caregiver services and adult day care.
All Medicare Advantage plans must match the coverage provided by Original Medicare. However, private insurance companies have the flexibility to offer additional benefits beyond what Original Medicare provides. That means added benefits vary significantly between plans. Not all Medicare Advantage plans will cover adult day care. For those that do cover it, make sure you understand the rules for coverage.
Medicare Advantage Institutional Needs Plans
An Institutional Special Needs Plan (I-SNP) is a type of Medicare Advantage plan that’s good for people who need the level of care provided by a facility. These plans don’t cover room and board, but they do cover medical care, like specialized treatment, care teams, and other health services.
Although Medicare doesn’t cover adult day care, there are other programs and nonprofit organizations that offer financial assistance. Here are a few alternatives:
Medicaid often covers adult day care services for seniors with low incomes. Check your state’s specific coverage requirements—each state has different Medicaid rules.
Veterans who have VA benefits may receive coverage for adult day care. VA Aid and Attendance and Housebound benefits offer financial assistance to eligible veterans and spouses who need adult day care services or home health aides.
Some long-term care insurance policies cover adult day care centers.
You can pay out of pocket for adult day services. Some facilities may offer a sliding scale payment system based on income.
Local nonprofit organizations, like the Alzheimer’s Association may cover adult day care or offer grants for financial assistance. Your local Area Agencies on Aging is also a good resource for financial assistance.
The Program of All-Inclusive Care for the Elderly (PACE) provides medical and social services to seniors, including adult day care. PACE is typically for more frail and elderly, low-income seniors.
Some of these programs, like Medicaid and VA benefits, can work hand-in-hand with Medicare to provide more comprehensive healthcare. Learn more about your Medicare options by talking to a Chapter Medicare Advisor at 855-900-2427 or schedule a time to chat.
