If you’re considering adult day care for a loved one, one of the most important questions to answer early on is: Will insurance or Medicaid cover the cost?
In 2025, more families are relying on adult day care as a flexible, affordable option to keep aging loved ones engaged, supervised, and safe during the day. But understanding how to pay for these services—and what’s covered—can feel overwhelming.
This guide breaks it down clearly.
Does Insurance Cover Adult Day Care?
The short answer: it depends.
Most traditional health insurance policies do not cover adult day care services, since these programs are classified as long-term care rather than acute medical care. However, some alternative options may help cover or offset the cost, depending on your situation.
Insurance Options That May Help
1. Long-Term Care Insurance
If your loved one has a long-term care insurance policy, there’s a strong chance adult day services are covered—especially if the individual needs assistance with activities of daily living (ADLs) or has a diagnosis like Alzheimer’s or dementia.
Coverage varies by provider and policy, so it’s important to:
- Contact the insurer directly
- Ask for specific language regarding “adult day services” or “community-based services”
- Clarify requirements for reimbursement (such as documentation or attendance logs)
2. Veterans Benefits
For eligible veterans and their spouses, the U.S. Department of Veterans Affairs may help cover the cost of adult day health care through VA-supported programs.
Veterans who qualify for VA Aid & Attendance or Community Care Programs may be eligible for partial or full coverage.
📍 Explore VA-supported programs at Penn Village
3. Medicare/Medicaid & Waiver Program Assistance – The Community Health Choices and OBRA Waivers
Unfortunately, Medicare alone generally does not cover Adult Daycare. However, In Pennsylvania and many other states, Medicaid may cover adult day services for eligible seniors. This often includes support through waiver programs that offer community-based care as an alternative to nursing homes. In Pennsylvania, adult daycare is covered through the Community Health Choices Waiver and OBRA waivers.
How Much Does Medicaid Pay for Adult Day Care?
Medicaid is one of the most common ways families pay for adult day care in 2025.
Medicaid coverage varies by state, but Pennsylvania offers Home and Community-Based Services (HCBS) and OBRA Waivers that include adult day health services. These programs are designed to help people remain at home instead of moving into full-time care facilities.
In Pennsylvania:
If your loved one qualifies, Medicaid and waiver programs can cover the full cost of attending adult day care. This includes services like:
- Supervision and personal care
- Meals and activities
- Transportation
- Basic health monitoring
📍 See how Penn Village supports Medicaid and waiver program assistance
To qualify, your loved one must meet:
- Medical necessity requirements (e.g., needs assistance with ADLs or supervision)
- Income and asset limits
Applying for waiver programs can take time, so families are encouraged to start the conversation early.
What If I’m Paying Out of Pocket?
Many families use a combination of private pay and financial assistance. Depending on your provider, you may also find:
- Sliding scale fees based on income
- Part-time rates for fewer days per week
- Trial days to test fit before committing
At Penn Village, we work with families to explore all payment options—including guidance on applications and documentation for Medicaid, VA, and long-term care insurance.
Why Coverage Matters
Adult day care is more than supervision. It helps:
- Delay institutional care
- Improve cognitive and physical health
- Support family caregivers’ mental and emotional well-being
- Prevent social isolation
That’s why coverage—whether through insurance, VA, or Medicaid—can be the bridge between getting by and truly thriving.
Let Us Help You Navigate the Process
Whether you’re just starting to explore adult day care or knee-deep in paperwork, know that support is available. Our team at Penn Village has helped hundreds of families navigate these programs and secure the funding they need.
👉 Contact us to discuss your loved one’s eligibility and find the right path forward.