Does Medicare cover adult day care? Here is what Original Medicare, Medicare Advantage, Medigap, Medicaid and the VA each pay for in Pennsylvania, and what to do next.
Penn Village Adult Day Care is a licensed adult day center at 200-220 W. Chelten Avenue in Germantown, Philadelphia. Older adults spend the day with us for activities, hot meals, nursing oversight and good company, and our vans bring them from home and back. “Will Medicare cover it?” is one of the first questions families ask us. This guide answers it, and covers what does pay for adult day care.
Original Medicare does not cover adult day care. Medigap plans do not either. Some Medicare Advantage plans include adult day services as an extra benefit, so it is worth calling the plan. In Pennsylvania, most families who get adult day care covered use Medicaid through Community HealthChoices, VA benefits or long-term care insurance.
Does Medicare cover adult day care?
No. Original Medicare (Part A and Part B) does not pay for adult day care. Medicare is built to cover medical care, such as hospital stays, doctor visits and short-term skilled care after a hospital stay. Adult day care is considered long-term support, so Medicare does not pay for the program itself. Medicare.gov explains its long-term care rules here.
Medicare may still pay for separate medical services your family member receives, such as outpatient physical therapy or doctor visits. Those are billed on their own, not as part of adult day care.
Do Medicare Advantage plans cover adult day care?
Some do. Since 2019, Medicare Advantage plans have been allowed to offer adult day services as a supplemental benefit. Whether a plan includes it, and how many days it covers, changes by plan and by year.
What to ask the Medicare Advantage plan
- Does my plan include an adult day care or adult day services benefit this year?
- How many days does it cover, and is there a copay?
- Does the center need to be in your network?
- Do I need a referral or prior approval?
The plan’s member services number is on the back of the card. Ask the questions above word for word.
Does Medigap cover adult day care?
No. Medigap (Medicare Supplement) plans help pay the costs Original Medicare leaves behind, such as deductibles and coinsurance. Because Original Medicare does not cover adult day care, Medigap does not either.
What if they have Medicare and Medicaid?
This is where many families find coverage. In Pennsylvania, people 21 and older who have both Medicare and Medicaid are usually enrolled in Community HealthChoices, the state’s Medicaid long-term care program. Adult day care can be part of a Community HealthChoices service plan, and the plan pays the center directly.
Many people are already enrolled without realizing it. If your family member has both cards, call their Community HealthChoices plan and ask for a service coordinator.
Not sure what their insurance cards cover? Read them to us and we will tell you.
Call 267-437-2898Does Medicaid cover adult day care in Pennsylvania?
Yes, for people who qualify. Pennsylvania Medicaid pays for adult day care through Community HealthChoices. Your family member usually needs to:
- Have Medicaid, or qualify for it based on income and assets.
- Need help during the day with things like bathing, dressing, medications, moving around or staying safe.
- Complete an assessment confirming that need.
When it is approved, Medicaid can cover the program day, meals and transportation. Penn Village accepts all three Community HealthChoices plans in Philadelphia. See Medicaid-approved adult day care for the step-by-step process, and understanding the Community HealthChoices waiver.
Do VA benefits cover adult day care?
Often, yes. Veterans may qualify through VA Adult Day Health Care, Veteran-Directed Care or Aid & Attendance, and surviving spouses may qualify too.
- Does the VA pay for adult day care?
- How to apply for VA Adult Day Health Care
- VA Aid & Attendance for adult day care
- Veteran-Directed Care and adult day care
- Aid & Attendance for a surviving spouse
See all of it on our VA adult day care page.
Does long-term care insurance cover adult day care?
Many long-term care policies include an adult day care or adult day services benefit. Call the insurer and ask:
- Does the policy cover adult day services, and what is the daily limit?
- Is there an elimination period before benefits start?
- What paperwork do you need, such as a care plan or doctor’s statement?
Regular employer or marketplace health insurance rarely covers adult day care.
Let us check coverage for you.
Call us with your family member’s insurance cards in hand. We will tell you what is likely to cover adult day care and what the next step is.
Adult day care coverage at a glance
| Coverage | Pays for adult day care? | What to do |
|---|---|---|
| Original Medicare | No | Look at the options below |
| Medigap | No | Look at the options below |
| Medicare Advantage | Some plans | Call the plan and ask about an adult day services benefit |
| Medicaid (Community HealthChoices) | Yes, if eligible | See our Medicaid page |
| VA benefits | Often | See our VA page |
| Long-term care insurance | Often | Call the insurer |
| Private health insurance | Rarely | Call member services to confirm |
If none of these apply, families pay privately. As a general estimate, adult day care in the Philadelphia area commonly costs around $75 to $150 per day. Call to confirm current pricing, and read how much senior day care costs.
Common questions about Medicare and adult day care
Does Medicare cover adult day care?
Original Medicare does not cover adult day care. Some Medicare Advantage plans include adult day services as an extra benefit. In Pennsylvania, Medicaid through Community HealthChoices and VA benefits are the most common ways families get adult day care covered.
Does Medicare cover senior day care?
No. Senior day care is the same service as adult day care, and Original Medicare does not pay for it.
Does Medicare Part B cover adult day care?
No. Part B covers outpatient medical services like doctor visits and therapy, but not the adult day care program itself.
Can someone with Medicare and Medicaid get adult day care covered?
Often, yes. In Pennsylvania, people with both are usually enrolled in Community HealthChoices, which can include adult day care in their service plan.
Does Penn Village accept Medicaid?
Yes. Penn Village accepts all three Community HealthChoices plans in Philadelphia, and works with VA benefits.
Is adult day care ever free?
For people who qualify for Medicaid or VA coverage, adult day care can cost little or nothing out of pocket.
More guides on paying for adult day care
Coverage rules change and vary by plan. Confirm details with the plan or program. This article is general information, not financial advice.
