Does Medicare Cover Adult Day Care Expenses?

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Adult day care is a valuable resource for family caregivers. Services are typically provided during daytime hours on weekdays, allowing a senior’s family members to go to work, attend their own doctor’s appointments, run errands or simply enjoy a break from caregiving.

There are different levels of adult day care services. Some centers offer basic social and recreational opportunities in a community setting while others provide specialized dementia care and close supervision for attendees. Adult day health care centers offer the highest level of care and are unique in that they provide skilled nursing services (physical therapy, medication administration, injections, etc.) in addition to senior activities and social programs.

According to the 2018 Genworth Cost of Care Survey, the average cost of a single day in adult day health care is $72. Some adult day centers charge by the hour, while others offer half-day and full-day rates. Compared to the costs of other types of care, such as in-home care, adult day care is one of the most flexible and economical options for short-term respite. However, many families still struggle to afford regular breaks, which are crucial for preventing caregiver burnout.

Does Medicare Pay for Adult Day Care?

Medicare alone does not pay for any of the kinds of adult day care mentioned above. However, Medicare Advantage (Part C) Plans that are sold by private insurance companies typically offer expanded coverage compared to Original Medicare (Parts A and B), which is administered directly by the Centers for Medicare & Medicaid Services (CMS). Certain Medicare Advantage Plans may provide partial coverage for adult day care services, but they are not required to do so.


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Does Medicaid Cover Adult Day Care?

Unlike Medicare, Medicaid will cover adult day care services and/or adult day health care services. Most states offer Home and Community Based Services (HCBS) Medicaid Waivers to seniors who have low income, few assets and a demonstrated need for skilled nursing care. These HCBS Medicaid Waivers provide services, such as adult day care, in-home care or care in an assisted living facility, that enable seniors to remain living in the community for as long as possible.

There may be a waiting list for supportive services like adult day care, depending on whether the state includes them in their basic Medicaid State Plan as an entitlement or uses a waiver program. Financial and functional eligibility requirements are unique to each state, but waiver programs typically have less restrictive financial guidelines and a cap on how many people can be served.

Medicaid coverage of adult day health care usually requires a health assessment and a physician’s order before a senior can be admitted into the program. These centers often provide rehabilitative physical, occupational and speech therapies, and staff include a registered nurse (RN), therapists and other health professionals. Specialized adult day care services for eligible seniors with dementia are also covered by Medicaid.

PACE Programs for Seniors

Seniors who have both Medicare and Medicaid are called “dually eligible.” These individuals can receive comprehensive care coordinated by a team of medical professionals through the Program of All-Inclusive Care for the Elderly (PACE). PACE health care services can be provided either in patients’ own homes, at an adult day health care center or in an inpatient facility. Some seniors who only have Medicare may also be able to enroll in PACE if they agree to pay premiums for these services.

Read: PACE Programs Provide Comprehensive Care for Seniors Who Need it Most

Other Ways to Pay for Adult Day Care

Private medical insurance policies will rarely cover a portion of adult day health care costs when licensed medical professionals are involved in the care. Long-term care insurance may pay for adult day services, depending on the details of a senior’s policy.

Veterans and their spouses may be able to receive financial assistance or respite care through the U.S. Department of Veterans Affairs. Eligible wartime veterans with low income and few assets may qualify for a pension to help offset care costs, and the Veterans Health Administration offers adult day health care and other respite options for veterans and their caregivers. To learn more about VA benefits and VA health care, visit VA.gov or call 1-844-MyVA311.

Lastly, there many local programs that might be able to help offset the costs of adult day care. Non-profit adult day centers may even use a sliding scale to adjust rates based on a senior’s income. Check with your nearest Area Agency on Aging for a list of resources and providers in your community.

Sources: Genworth Cost of Care Survey 2018 (https://www.genworth.com/aging-and-you/finances/cost-of-care.html)

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