Medicare vs Medicaid for Home Care in Texas: What Each Actually Pays For (2026)

This is the single most-confused topic in home care. Medicare, Medicare Advantage, and Medicaid sound similar; they cover very different things. Getting this wrong costs Houston families thousands, or worse, delays care while paperwork gets sorted.

Here is what each program actually pays for in Texas in 2026.

Quick summary

Traditional Medicare (Parts A & B) does not cover ongoing non-medical home care. Full stop. It covers short-term skilled home health (nursing, PT, OT, speech) for people who are homebound and recovering from an event.

Medicare Advantage (Part C) plans SOMETIMES include limited in-home support services (IHSS) — a few hours of non-medical home care per week — as a supplemental benefit. Coverage varies wildly by plan.

Medicaid STAR+PLUS (the Texas Medicaid waiver for aged and disabled adults) covers ongoing personal care services in the home for people who meet income, asset, and functional eligibility. This is the most complete coverage but has strict eligibility limits.

Long-term care insurance (LTCI) is a private product, not a government program, and is usually the most flexible coverage for people who bought a policy years ago.

Below is the detail.

Traditional Medicare (Parts A & B)

What it pays for:

- Medicare-certified home health agency care (nursing, physical therapy, occupational therapy, speech therapy, medical social work) for people who are:

1. Homebound (leaving home requires substantial effort)

2. Under a physician's plan of care

3. Need intermittent (not continuous) skilled nursing or therapy

- Typically covered as a 60-day "episode" of care after a hospital discharge or a physician-ordered plan.

What it does NOT pay for:

- Ongoing non-medical home care (companion care, personal care, help with bathing/dressing/toileting without a skilled need)

- 24-hour or live-in caregivers

- Meal preparation, housekeeping, transportation

- Long-term chronic care

The gap Houston families face: After the 60-day Medicare-certified home health episode ends, the person still needs help with bathing, meals, and mobility, but Medicare won't pay for it. This is the #1 reason families discover private home care.

Medicare Advantage (Part C)

What it pays for:

- Everything Traditional Medicare covers

- PLUS: variable supplemental benefits that CAN include:

- In-home support services (IHSS) — usually a few hours per week of non-medical home care

- Adult day services

- Home modifications

- Meal delivery after a hospital stay

- Transportation to medical appointments

The reality in Houston: Coverage varies dramatically by plan. Kelsey-Seybold, Wellcare, HAP, and Humana plans in Harris County each offer different supplemental benefits, and even within one plan, the benefit specifics (how many hours per week, for how many weeks) differ.

How to find out what YOUR plan covers:

1. Call the plan's member services line (on the back of the ID card).

2. Ask: "Does my plan include an in-home support services benefit, and if so, how many hours per week and for how long?"

3. Get the answer in writing (they'll mail or email a benefits summary).

Our free service: If you send us your Medicare Advantage card, we run the eligibility check and tell you within 48 hours what home care benefit is available on your plan. No sales call attached.

Medicaid STAR+PLUS (Texas)

What it pays for:

- Long-term services and supports for aged and disabled adults, including:

- Personal Assistance Services (PAS) in the home

- Community-based residential services (assisted living)

- Adult foster care

- Care coordination

Eligibility (2026 Texas thresholds — verify current amounts with Texas HHSC):

- Age 65+ OR disabled

- Income: approximately $2,829/month for an individual (300% of SSI)

- Assets: approximately $2,000 for an individual (excluding home, one car, personal effects, prepaid burial)

- Functional need: requires assistance with activities of daily living (assessed by Texas HHSC)

How to apply: Contact your local Texas HHSC office or a Medicaid enrollment counselor. The process typically takes 60-90 days from application to services starting.

The reality in Houston: STAR+PLUS is a comprehensive benefit but the income and asset limits exclude most middle-class Houston families. Those who qualify get substantial coverage; those who don't qualify face the full private-pay cost.

Medicaid planning: Some families work with an elder-law attorney to legally restructure assets (typically 5+ years before care is needed, due to the Medicaid lookback period) to become Medicaid-eligible. This is a serious legal decision and requires professional guidance.

Long-term care insurance (LTCI)

What it pays for:

- Non-medical home care, adult day services, assisted living, and nursing facility care once the "activities of daily living" trigger is met (typically needing help with 2 of 6 ADLs: bathing, dressing, toileting, transferring, continence, eating).

Coverage details:

- Daily benefit: typically $150-$300/day for policies purchased 2005-2015

- Elimination period: 30, 60, or 90 days (the person pays out of pocket during this period before benefits begin)

- Benefit period: typically 3, 5, or unlimited years

Reality in Houston: LTCI is the most flexible coverage for people who bought a policy. Direct-billing agencies (like ours) submit claims to the carrier and the family never sees the paperwork. If you have a policy and don't know what it covers, we do free policy reviews.

VA Aid & Attendance

If the person needing care is a wartime veteran or the surviving spouse of one, the VA's Aid & Attendance pension can pay $1,881-$2,795/month toward home care (2026 rates, verify with VA).

Eligibility involves wartime service dates, income limits, and functional need. It's under-utilized because many families don't know about it. See our [VA Aid & Attendance guide](/family-guide/va-benefits-home-care/) for the Houston-specific process.

Putting it together for a Houston family

Scenario A: Recently retired, private pay, no LTCI.

Medicare covers the post-hospital episode; everything else is private pay ($30-$45/hr). If wartime veteran: VA A&A adds $2,000/month. If Medicare Advantage: check for IHSS supplemental benefit.

Scenario B: Retired, has LTCI purchased in 2010.

LTCI covers the bulk once the ADL trigger is met and the elimination period is served. Medicare covers post-hospital skilled care. Net out-of-pocket often drops 60-80%.

Scenario C: Low income, low assets, needs help with 2+ ADLs.

Apply for Medicaid STAR+PLUS. In the 60-90 days while applying, some families pay a reduced private rate to bridge the gap; others rely on family caregiving. Adult day services (also STAR+PLUS covered) are a cost-effective bridge.

Scenario D: Wartime veteran, over Medicaid income/asset limits, no LTCI.

VA A&A + private pay is the typical path. Some VA-friendly agencies (including ours) accept the A&A pension as partial payment and bill the family the difference monthly.

What to do this week

1. Find out what your Medicare Advantage plan covers (call member services).

2. If there's an LTCI policy, dig it out and read the benefit summary. Or send it to us for a free review.

3. If income and assets are low, look up Texas HHSC STAR+PLUS eligibility.

4. If wartime veteran, look up VA Aid & Attendance eligibility.

5. Call 713-766-0908 for a free consultation. We'll help you map your specific coverage before you commit to any care plan.

*Serhat Bolukbasi is CEO and co-owner of Homewatch CareGivers of Houston Galleria. He holds an MBA from Northwestern Kellogg and was previously a Principal at The Boston Consulting Group.*