Nervous about the costs of senior care? If so, you’re not alone. One study found that while over 82 percent of adults think it’s a good idea to talk about money with aging relatives, only 23 percent have done so. Conversations about paying for elderly support services such as adult day care can be awkward, uncomfortable, and just plain confusing. You may have questions like, How much will on-site services cost? Are most adult day programs covered by public or private insurance? What’s the difference between Medicaid and Medicare, anyway?
Such concerns are understandable. Still, addressing the financial side of care is necessary to ensure your family is prepared for the future—and the earlier you do so, the better to relieve stress on the caregiver and the individual cared for. To help you in this endeavor, this article addresses the ins and outs of paying for adult day care services. Whether you’re currently investigating programs for a loved one or just beginning to consider the options, you’ll find information about the financial side of this rapidly-growing branch of senior care.
In recent decades, more and more families have been turning toward aging-in-place care options. Not only do these services allow loved ones to age in a comfortable, familiar setting, but they are also often less costly than 24-hour care facilities. In 2019, the average cost of a shared nursing home room was $7,513 per month ($8,517/month for a private room). Compare this to the following in-home services:
Consequently, in-home options can provide needed services at lower rates for older adults who need mild to moderate assistance and wish to remain in their own homes. Considering that both medical and non-medical care services are often enlisted part-time, costs may be even lower than the average assisted living facility, a comparable residential option ($4,051/month). And at $1,625 per month, or approximately $75 per day, adult day care services are available at the lowest monthly rate out of possible in-home options, providing an environment in which seniors can receive needed care as well as community engagement for part of the day.
What is typically included in the cost of adult day services? The 2010 MetLife Study of Adult Day Services estimates the percentage at which services are free or included in the daily cost of such programs in the US. Services include:
When exploring any adult day care center, it is important to ask which services will be included in the listed price. Further, asking questions like, Does this center require an admissions deposit? or Does it qualify for Medicaid or VA benefits? will better prepare you in determining how your family will pay for services. Here is a more extensive list of questions to ask while touring adult day care programs.
When investigating senior day programs for your loved ones, it is also a good idea to learn the average program costs in your state. Pennsylvania is 13th on the list of states ranked from least to most expensive adult day care services, with an average rate of $65 per day. Most centers are transparent about their costs; for example, Senior Day Services’ on-site adult day program, which includes assistance with activities of daily living, medical care management, meals, and transportation among other services, costs $68 per day. If you are uncertain about the costs of care in your area, use the Genworth calculator to get an estimate by ZIP code.
At approximately $75 per day or $1,625 per month, adult day care services are one of the least expensive care options for those who wish to age in place, need assistance with daily activities of living, and seek to engage with peers. Private payment options such as retirement funds, savings, long term care insurance, reverse home mortgages and employee benefits have been noted as viable ways to afford adult day care services. Yet, paying the typical monthly price out of pocket can be challenging for many families. Listed below are programs focused on supporting seniors financially and to what extent they can (or cannot) help pay for adult day care services.*
What is Medicare? Medicare is a federal health insurance program for seniors and individuals with disabilities. Any U.S. citizen at least 65 years old is eligible for full Medicare benefits if they or their spouse 1) have paid Medicare taxes on their income for at least ten years and/or 2) are eligible for Social Security or railroad retirement benefits.
Does It Pay for Adult Day Care Services? No, Medicare generally does not pay for adult day care services. Medicare covers medical care including hospital visits (Part A), outpatient services (Part B) and prescription drug coverage (Part D). Adult day care services are designated as non-medical custodial care.
What Is Medicare Advantage? Medicare Advantage (also called Medicare Part C) allows senior to receive Medicare benefits through private insurance companies. The eligibility requirements are the same and packages typically include Parts A, B, and D along with coverage not available through traditional Medicare.
Does Medicare Pay for Adult Day Care Services? Sometimes. Due to major policy changes in 2019, Medicare Advantage plans are now allowed to include supplemental health care benefits including adult day coverage. However, since these programs are run by a variety of private companies, plans and costs will vary widely.
What Is Medicaid? Medicaid is a jointly funded state and federal health insurance program for low-income adults and children, pregnant women, seniors, and individuals with disabilities. Medicaid eligibility is based on financial and medical need. Adults ages 65 and older may qualify for both Medicare and Medicaid. In these cases, Medicaid can help cover Medicare premiums and expenses not covered by Medicare.
Does Medicaid Pay for Adult Day Care Services? Yes, Medicaid generally pays for adult day care services, especially for those who require medical-based care. As Medicaid is partly state-funded, each state has its own options and limits on adult day care benefits offered.
Veteran’s Affairs (VA) Health Benefits
What Are VA Health Benefits? VA health benefits are open to all veterans who have served in the active military, naval, or air service and did not receive a dishonorable discharge. Veterans with specific financial, medical, and service-related circumstances may qualify for enhanced eligibility and thus will be more likely to receive benefits. Once enrolled, veterans receive comprehensive coverage of preventative, inpatient and emergency health services.
Do VA Health Benefits Cover Adult Day Care Services? Yes, VA health benefits may partially or fully pay for adult day care services. Typically, VA benefits will cover medication management, blood pressure monitoring, and other health-related costs of adult day services, though coverage of social or respite care may be restricted. Any enrolled veteran is eligible to receive this coverage if 1) they are eligible for community care, 2) they meet the clinical criteria for the service and 3) it is available. Special benefits such as Aid and Attendance, which is intended for aging or disabled veterans who require the assistance of an attendant in the home, can also cover adult day care services.
Private Medical Insurance
What Is Private Medical Insurance? Private medical insurance is any insurance not offered by the state or federal government. Typical private insurance options include state or federal marketplace plans, group plans offered through an employer, or plans offered by a licensed agent or broker.
Does Private Medical Insurance Cover Adult Day Care Services? Rarely. Private insurance will in some cases cover a portion of adult day care services when licensed medical professionals are involved in care, but not socialization or respite services.
What Are State-Specific Alternatives? State-specific alternatives are non-Medicaid assistance programs which provide support for eligible seniors in order to prevent or delay placement in nursing homes. These programs are typically connected with the local Area Agency on Aging. Here is a list of alternative assistance programs by state.
Do State-Specific Programs Cover Adult Day Care Services? Yes, these programs will often help pay for adult day care services for qualifying seniors. If you or your loved one is seeking help to pay for adult day care services in Lackawanna County, contact the Lackawanna County Area Agency on Aging and ask to speak with a care manager who can conduct an assessment to determine eligibility for financial support.
*Every adult day care program has its own list of accepted payment options which may or may not include those listed above. Be sure to ask the centers you are considering which types of payment they will accept. Staff at Senior Day Services, a program for seniors in Northeastern Pennsylvania, are available to help you with specific questions on programs serving older adults in Lackawanna, Luzerne and Wayne Counties.
Navigating the costs of senior care can be daunting, but you’re not alone. If you have further questions about paying for Senior Day Services’ adult day care program, please reach out to our social worker, Julie Condrad. Ultimately, understanding the costs of adult day care services and investigating potential avenues of payment will ease the transition for you and your loved one into this next stage of life and care.