Does Medicare cover adult daycare? It’s a natural question for caregivers to ask. After all, taking care of a senior or disabled person can be time-consuming. Primary caregivers usually sacrifice their jobs and personal time to be constantly available for them.
Thankfully, there are adult daycare facilities where you can drop off your loved ones for a few hours a day while you work, run errands, or catch some downtime. These facilities provide a safe and supervised environment where seniors and disabled individuals can socialize while receiving the necessary daily assistance.
Sadly, adult day care can be expensive, and many primary caregivers simply can not afford it. Given that most senior citizens have Medicare plans, the question of whether adult Medicare covers adult daycare comes up quite often.
Key Takeaways
- Original Medicare generally does not cover adult day care. However, some Medicare Advantage plans do.
- In rare cases, Medicare Original may cover some services offered by adult day care. But, this is available mainly to individuals with mental health conditions.
- Other funding sources for adult day care include Medicaid, Veteran Benefits, and state-funded assistance schemes.
- Caregivers who do not qualify for adult daycare funding can deduct the cost of adult daycare under dental and medical expenses before paying tax.
Does Medicare Cover Adult Daycare?
In order to understand if Medicare covers this service, it’s important to understand that there are different types of Medicare. Coverage will often be different depending on which type of Medicare the patient has.
Original Medicare
Original Medicare, i.e., Medicare Part A and Part B, do not cover adult day care.
- Part A (hospital insurance) covers hospital bills like inpatient hospital care, home health care services, and nursing facility care. Many seniors qualify for this Medicare plan without needing to pay a premium.
- Medicare Part B (medical insurance) covers preventative medical services and medically necessary services. This includes outpatient care, medical supplies, and medically necessary home services.
Original Medicare primarily focuses on medical care. Only situations that fall under this umbrella can be covered by Medicare. Unfortunately, adult daycare doesn’t fall under this table. They offer social activities, meals, and care to older or disabled citizens, but not necessarily medical care.
On some rare occasions, Medicare Original may cover some services offered in an adult daycare, especially those related to specific mental health care. However, eligibility requirements are strict and only applicable when it covers mental health treatment like:
- Crisis recovery as prescribed by a doctor
- Outpatient mental health services provided by clinics that also offer adult day care services
- Administration and monitoring of prescription.
Medicare Advantage
On the other hand, Medicare Advantage (part C) plans, offered by private insurance companies often provide additional coverage that extends beyond what Original Medicare offers. Sometimes this may include adult day care services.
Note that they are not mandated to cover adult day care. And even when they do, the coverage may be limited. As a result, you should review and discuss your plan extensively with your broker to be sure it includes adult daycare coverage.
Are You Eligible for Medicare-Covered Adult Daycare?
Now that we’ve established that Medicare might cover adult daycare on rare occasions, let’s explore how to determine if your loved one is eligible for adult daycare.
- Review Their One’s Medicare Coverage
Start by reviewing your loved one’s present Medicare coverage. Find out if they have an Original Medicare (Part A and B) or Medicare Advantage (Part C) plan. Then carefully review its guidelines. Remember that Original Medicare doesn’t cover adult day care in most cases.
If they have a Medicare Advantage plan, you must carefully review its details and guidelines, too.
If you still need more clarification, don’t hesitate to schedule a meeting with your broker. A detailed understanding of what your loved one’s plan covers will help avoid unnecessary out-of-pocket expenses.
- Review Their Medical History
It’s also important you have a comprehensive understanding of your loved one’s medical history and present medical condition. A comprehensive understanding of their condition can help you determine if they are eligible for Medicare daycare coverage.
If you have any questions or feel overwhelmed by the information, schedule a meeting with their doctor to gain more clarity.
Remember that Original Medicare covers some adult day care services for individuals who have specific mental health issues like dementia or seniors who are recovering from a medical crisis.
- Consult A Medicare Counselor
Medicare guidelines can be difficult to understand. The abundance of information online often leads to information overload. It’s not uncommon for caregivers to have several questions. Thankfully, you don’t have to navigate these waters alone:
- You can contact Medicare directly by visiting their official website or calling them at 1-800-MEDICARE (1-800-633-4227).
- State Help Insurance Assistance Programs (SHIP) are available in every state. SHIP counselors offer free one-on-one counseling for individuals who need clarity on their Medicare plans.
- Medicare Rights Center is a nonprofit organization with counselors on hand to answer any questions you have on Medicare plans, guidelines, and claims. Reach them via their national helpline at 800-300-4114 or visit their website at Medicareinteractive.org.
- Check Your Loved One’s Eligibility for State or Local Coverage Schemes
Apart from Medicare, other state or local programs assist caregivers with offsetting the cost of adult day care — we’ll explore more of this later.
These programs have their distinct eligibility and registration requirements. They also have different guidelines and extent of coverage. You can consult your local Department of Social Services or Agency on Aging to discover if your loved one qualifies for any available programs.
Alternatives to Medicare-Covered Adult Daycare
If your loved one does not qualify for adult daycare coverage under Medicare, you can consider any of the following options:
- Long-Term Care Insurance: Long-term care insurance policies differ; some might cover adult day care services. If you’ve purchased a long-term care insurance policy or intend to, it’s important you properly review its terms and conditions to determine if it covers adult day care services too.
- Veteran Programs: Several veteran health care programs cover adult daycare expenses.
- The Veterans Aid and Attendance benefit is available to ailing and disabled veterans and can be used to fund adult day care.
- Veterans Directed Care also provides funds that can be used to offset adult daycare bills.
- VHA medical benefits package pays for adult day care, but only for individuals who would otherwise need to stay in a skilled nursing home. This means the benefit is only available to veterans with serious health issues. To be accepted into this program, the VA will first assess your loved one to ascertain that they need that level of care and supervision. To learn more about VA benefits, visit VA.gov or call 1-844-MyVA311
- Medicaid: Depending on the state, senior citizens who qualify for Medicaid may also be eligible for adult daycare assistance. For more information on eligibility and requirements contact your state’s Medicaid office.
- State-Funded Assistance for Adult Day Care: Apart from Medicaid, many states offer daycare assistance programs for seniors to prevent or delay the placement of senior state residents in nursing homes. These programs usually prioritize individuals with Alzheimer’s or Dementia. You can find out more by contacting your state’s Agency on Aging.
FAQs about Medicare & Adult Daycare
Diving into the world of Medicare and adult daycare can bring up quite a few questions. Here, we’ll tackle some of the most common FAQs to help clear up any confusion and guide you through your options.
Are There Exceptions Where Medicare Covers Adult Day Care?
The only exception where Medicare covers adult day care is when the senior citizen has a mental health condition.
What Other Options are Available to Caregivers?
Caregivers who don’t qualify for daycare funding can deduct the cost of daycare under medical and dental expenses before calculating tax. If your relative is your dependent, you can deduct It under the Dependent Care Credit.
Does Medicare Cover Home Care Services?
Medicare covers home care services, but there are conditions tied to it. These include — if the senior requires skilled nursing for less than eight hours a day, less than seven days a week, and no more than three weeks.
Relief Recap
So, does Medicare cover adult daycare? No, Medicare usually does not cover adult daycare. But in some rare cases, Original Medicare may cover some services for specific mental health conditions. Medicare Advantage may offer some coverage, but you must confirm if your specific plan offers it or call your private insurance provider to find out. State or local programs, long-term care insurance, Veteran programs, Medicaid, and a few other options may assist with adult daycare services.
Faith Boluwatife
Faith is a passionate advocate for social change. She brings a unique blend of professional expertise and personal experience to the discourse on poverty. With a background in humanities and an advanced degree on public health, she has dedicated years to working directly with marginalized communities, both as a volunteer and a seasoned professional.