Does Medicare Cover Day Care?

Adult daycare can be beneficial for family members who need to run an errand or take a break from caregiving. They can temporarily transfer their elders to an adult daycare for caregiving during the day. Adult daycare provides many services which include high-level skilled nursing care, specialized dementia care, and community social and recreational activities.

If this is a service you are considering, you may want to know “does Medicare cover day care?” In this article, we answer that question in clear, plain English. You will also find the average costs of adult daycare and other helpful info.

The short answer is no. In most cases, Medicare will not cover the cost of stays in an adult daycare. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your adult daycare.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for stays in an adult daycare. Even though there are many medical services and care given in an adult daycare, Original Medicare does not provide coverage for adult daycare as it is considered custodial care.

Original Medicare does not provide coverage for adult daycare stays unless the patient has been officially admitted to hospice care. This process is called respite care. Coverage for inpatient respite care is provided by Medicare Part A. Medicare Part A provides coverage for any services, treatments, and care that takes place in an inpatient setting such as respite care.

Medicare Part A provides coverage for up to 5 days of inpatient respite care. Though you can get inpatient respite care more than once, Medicare Part A will only cover it on an occasional basis.

Medicare Part A may also provide coverage for mental health services in an adult daycare which includes the administration of medication and recovery from a medical crisis.

Even though Original Medicare does not provide coverage for adult daycares, they, in partnership with Medicaid, sponsor a program called PACE. PACE stands for Program of All-Inclusive Care for the Elderly. The program requires home and community care, which includes adult daycare, for seniors who need skilled nursing care.

However, PACE is not available in all states. Additionally, to be enrolled in PACE, is its required that you:

Are a low-income senior and you are enrolled in Medicare, Medicaid, or both
Live in an area where there is a PACE organization
Need skilled nursing care
Can live safely at home with the assistance of PACE

Part C Coverage for Day Care

However, Medicare Advantage plans (Medicare Part C) provide coverage for adult daycares. By law, Medicare Advantage plans have to provide coverage for everything Original Medicare covers. The Advantage plans, however, will also cover things that Part A & B do not. Exactly what a plan covers and what the costs are for the plan (ie. premiums, copays, etc.) varies depending on the plan you choose.

How Much Does It Cost To Stay In An Adult Daycare?

The average daily rate of staying in an adult daycare for up to eight hours is $75. This cost varies from state to state.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.