Does Medicare Pay for Adult Day Care?
Medicare Might Cover Some Adult Day Care Costs
If an adult is ill or disabled, she's eligible to get help from home care services and avoid moving into a nursing home.
Home services include adult day care services and Meals on Wheels programs. Adult day care services help an adult get out of the house for the day. Meals on Wheels deliver food to the adult at home by friendly volunteers. Most local communities offer programs like these.
Depending on the situation, Medicare and private insurance may pay some home care costs that relate to medical care.
Does Medicare Pay for Adult Day Care
Medicare covers medical care for Alzheimer's patients. It does not pay for non-medical custodial care, like adult day care.
In some limited cases, Medicare covers services offered through an adult day care center. It covers mental health treatments like:
- Administration and monitoring of medication
- Recovery from a medical crisis when prescribed by a physician
- Outpatient mental health services by a clinic that provide adult day care
Some Part C Medicare Advantage managed care plans offer limited adult day care coverage as part of their comprehensive home care services. Medicare does not require managed care plans to offer comprehensive care services, so check with your plan to find out if your Advantage plan covers adult day care services.
Medicare partners with Medicaid to sponsor what's called the Program of All-Inclusive Care for the Elderly (PACE). This program provides comprehensive home and community care, including adult day care, for frail elders who would otherwise require nursing home care.
PACE is only available in certain states and in those states, eligibility for the PACE program has restrictions. PACE is primarily for low-income seniors who are eligible for both Medicare and Medicaid.
PACE (Program of All-inclusive Care for the Elderly), headed up by Medicare and Medicaid, helps people get needed health care in the community instead of moving to a nursing home or another care facility.
With PACE, a team of health care professionals work with you and your family to receive the care you need. The PACE team has experience in giving care.
When a person enroll in PACE, one's required to use a PACE-preferred doctor who is best suited to help you make health care decisions.
Who qualifies to receive PACE?
You can have either Medicare or Medicaid, or both, to join PACE. PACE is only available in some states that offer PACE under Medicaid. To qualify for PACE, you must:
- Be 55 or older
- Live in the service area of a PACE organization
- Need a nursing home level of care (as certified by your state)
- Able to live safely at home with help from PACE
Learn more about PACE.
What does PACE cover?
The care and services covered by Medicare and Medicaid using PACE:
(If your health care team decides you need care and services that Medicare and Medicaid doesn't cover, PACE may still cover them.)
Here are some of the services PACE covers:
- Adult day primary care (including doctor and recreational therapy nursing services)
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Prescription drugs
- Preventive care
- Social services, including caregiver training, support groups, and respite care
- Social work counseling
- Transportation to the PACE center for activities or medical appointments, if medically necessary
Find out if you qualify for PACE - Medicare contacts.
To learn more about Medicare payment for care costs, contact your Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in your State. The contact information for the Medicare Fiscal Intermediary or SHIP office in your area.
Here is a list of all states participating in the PACE Program.
Dependent Care Tax Credits
What many people do not realize is that dependent care tax credits are available to the caregiver. In order to claim this tax credit, you must meet each of following criteria:
- Your child or dependent must meet certain qualifications
- Your daycare provider must meet certain qualifications
- You must have earned income
- The care provided must enable you to work or to look for work
- You must reduce your eligible daycare expenses by any amounts provided by a dependent care benefits plan through your employer
There are other rules in place to meet the guidelines for dependent care credit so speak to your personal accountant for more information.
Other Pay Options for Adult Day Care
Social Managed Care Plan
A Social Managed Care Plan provides the full range of Medicare benefits by standard Managed Care Plan's. These are membership plans and offer other health benefits not provided through Medicare alone or most other senior health plans.
The services the organization offers home and community based services:
- Care coordination
- Prescription drug benefits
- Chronic care benefits covering short-term nursing home care
- Personal care services
- Adult day care
- Respite care
- Medical transportation
- Hearing aids
- Dental benefits
Where to Find Social Managed Care Plans
There are currently four Social Managed Care Plan's participating in Medicare and each Social Managed Care Plan has eligibility criteria.
- Portland, Oregon
- Long Beach, California
- Brooklyn, New York
- Las Vegas, Nevada
If you live in one of the states offering Social Managed Care, go directly to the companies listed below to get benefit information.
- Kaiser Permanente, Portland Oregon
- SCAN, Long Beach California
- Elderplan, Brooklyn, New York
- Health Plan of Nevada, Las Vegas, Nevada
Private medical insurance policies sometimes cover some adult day care center costs when licensed medical professionals involved in the care. Long-term care insurance may also pay for adult day services, depending on the policy.
Medicare Funded Programs
Check with your local state health agencies and the local AoA to find out if your loved one is eligible for adult day health care through Medicare..
State governments constantly battle between cutting funds to locating more money for adult services. As a result, some have added community-based health day care.
In general, custodial adult day care is not covered by Medicare, although Medicaid covers some costs or other insurers do.
After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.
- What is Adult Day Care?
- Benefits of Adult Day Care
- Services Offered in Adult Day Care
- Who uses Adult Day Care?
- Adult Day Care Staff
- Selecting an Adult Day Care Facility
- Community Based Adult Day Care
- What to Expect as an Adult Day Care Client