Will insurance pay for virtual adult daycare classes?
To start, let us first state that we are not insurance experts.
However, we do know that some insurance plans will cover a senior’s adult daycare classes or in-home care, so we’re happy to offer you some initial guidance. Please be sure to check your plan for your exact benefits.
The information below was provided by our friend, Alan Brooks, at Mutual of Omaha.
What Is Long-Term Care?
This kind of care is different from medical care, because it generally helps you to live as you live now instead of improving or correcting medical problems. People often think of long-term care as strictly nursing home care.
Long-term care services actually may include help with activities of daily living, home care, respite care, hospice care, or adult day care. This care maybe given in your own home, an adult day care facility, assisted living facility, nursing home or hospice facility.
How Might I Pay for Long-Term Care?
People pay for long-term care in different ways. These include individuals’ or their families’ personal resources, including savings, investments or other assets such as a home, long-term care insurance and some help from Medicaid for those who qualify. Medicare, Medicare supplement insurance, or your employee or retiree health insurance usually will not pay for long-term care.
Medicare
Medicare does NOT cover long-term care. However, Medicare Part A does cover skilled nursing facility care, nursing home care (as long as custodial care isn’t the only care you need), hospice care and limited home care. You should NOT count on Medicare to pay your long-term care costs. Please see this Medicare guide for more information
Medicaid
Medicaid is the government-funded program that pays for nursing home care only for individuals who are low income and have spent most of their assets. Medicaid pays for nearly one-third of all nursing home care in the U.S., but many people who need long-term care never qualify for Medicaid assistance.
Medicaid also pays for some home- and community-based services.
To get Medicaid help, you must meet federal and state guidelines for income and assets. State laws differ about how much income and assets you can keep and still be eligible for Medicaid. (Some assets, such as your home, may not keep you from being eligible for Medicaid.) However, federal law requires your state to recover from your estate the costs of the Medicaid benefits you receive, subject to certain rules. Contact your state Medicaid office, state office on aging, or department of social services to learn about the rules in your state. The health insurance assistance program in your state also may have some Medicaid information.
What Services Are Covered by Long-Term Care Insurance
It’s important that you understand what services your long-term care insurance policy covers and how it covers the many types of services you might need to use. Policies may cover the following:
Nursing home care
Home care
Respite care
Hospice care
Personal in-home care
Services in assisted living facilities
Services in adult day care centers
Services in other community facilities
Policies may cover home care in several ways. Those who may provide care may be limited by your policy or state requirements. For instance, services may need to be provided from a licensed provider or agency. Other policies may pay for services from home care aides to help with personal care who may not be licensed or aren’t from licensed agencies.
You may also find a policy that pays for homemaker services or chore worker services. This type of benefit, though not available in all policies, would pay for someone to come to your home to cook meals and run errands. Generally, adding home care benefits to a policy increases the cost of the policy.
You should know what types of facilities your long-term care policy covers. If you’re not in the right type of facility (described in your policy), the insurance company can refuse to pay for your care. There may be other options for elder care in the future. Your policy might not cover those, but you always should check with your insurance company before making plans for your care.