Does Medicare Cover Adult Day Care for Alzheimer's Patients?

A fellow caregiver asked...

Does Medicare cover adult day care for Alzheimer’s patients?

Expert Answer

Medicare covers medical care for Alzheimer’s patients, but does not cover non-medical custodial care, which is most of what adult day care provides. Medicare can cover services from an adult day care center only in very limited circumstances. It can cover actual mental health treatment – administration and monitoring of medication, for example, or recovery from a medical crisis -- prescribed by a physician, and provided at an outpatient mental health clinic. If this clinic is also an adult day care center, the patient can get the benefit of the center’s other care service while receiving treatment there.

Some Part C Medicare Advantage managed care plans offer limited adult day care coverage as part of their comprehensive home care services. Medicare does not require these plans to offer this, so the nature and extent of what they cover depends entirely on the plans themselves.

Also, Medicare partners with Medicaid to sponsor what’s called the Program of All-Inclusive Care for the Elderly (PACE). This provides comprehensive home and community care, including adult day care, for frail elders who would otherwise require nursing home care. PACE is only available in certain states, however. And in those states, eligibility for PACE may be restricted to those low-income seniors who are eligible for both Medicare and Medicaid. See Medicare’s official web site for a list of PACE programs.