McAllen Senior AdvisorDoes Medicare pay for assisted living or adult day care in Texas?
No. Medicare does not pay for assisted living rent or care, long-term nursing home stays, adult day care or hourly attendant care; those are paid privately, by long-term care insurance, by the VA, or by Medicaid through STAR+PLUS.
Medicare Advantage plans, which many Valley seniors carry, sometimes add small supplemental benefits such as a few hours of in-home help or transportation to appointments. Check the plan's evidence of coverage; these extras are limited and are not long-term care.
How much nursing home rehab does Medicare cover?
After a qualifying inpatient hospital stay of at least three days, Medicare Part A covers skilled nursing facility care in full for days 1 to 20 and with a daily coinsurance for days 21 to 100, as long as the patient needs and is improving with daily skilled care.
Time spent under observation in the hospital does not count toward the three days, a frequent surprise after an emergency visit. Medicare Advantage plans set their own rules and often require prior authorization for rehab. In Hidalgo County, most nursing homes accept Medicare rehab admissions; the discharge planner at Rio Grande Regional, DHR, South Texas Health System, Mission Regional or Knapp will give you a list.
Does Medicare pay for home health in McAllen?
Yes. Medicare pays in full for part-time skilled nursing, physical, occupational and speech therapy and home health aide visits for a homebound patient under a physician's plan of care, provided by a Medicare-certified home health agency.
HHSC's directory lists 177 home health agencies with offices in Hidalgo County, 87 of them certified so they can bill Medicare or Medicaid; an office's address does not limit where its staff travel. Only certified agencies can bill Medicare, so check the certification before accepting a referral. Home health visits are short and intermittent; they are not a substitute for an attendant who stays for hours.
Does Medicare pay for hospice in the Valley?
Yes. The Medicare hospice benefit pays for comfort-focused care for a person whose physician certifies a life expectancy of six months or less if the illness runs its normal course, wherever the person lives: at home, with family, in assisted living or in a nursing home.
HHSC lists 52 licensed hospices with offices in Hidalgo County, mostly in McAllen and Edinburg, and hospices based elsewhere in the Valley also serve the county. Hospice does not pay room and board in a facility, and a patient can leave hospice and return to curative treatment at any time.
Where can McAllen families get free Medicare advice?
HICAP, the Texas Health Information, Counseling and Advocacy Program, gives free, unbiased Medicare counseling statewide at 1-800-252-9240, and the Area Agency on Aging of the Lower Rio Grande Valley offers benefits counseling for people 60 and older at (956) 682-3481.
Counselors help compare Medicare Advantage and supplement plans, sort out Part D drug plans, and check eligibility for the Medicare Savings Programs and Extra Help, which can lower premiums and drug costs for people with limited income.
Side by side
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Rehab | Up to 100 days of skilled nursing after a qualifying stay | Long-term custodial nursing home care |
| Home | Intermittent skilled home health visits | Hourly attendants or homemakers |
| Dying | Hospice care wherever the person lives | Room and board in a facility |
| Day care | Nothing | Adult day (DAHS) attendance |
Sources: Texas Health and Safety Code ch. 247 and 242; 26 TAC chapters 553, 554, 558 and 559; HHSC directories, TULIP and handbooks; CMS; CareScout; VA rate tables, as cited above. See our editorial standards.
