Medicare is a federal health insurance program for people 65 and older (and some younger people with disabilities). It covers medically necessary healthcare services regardless of income. Medicaid is a joint federal-state program that covers healthcare and long-term care for people with limited income and assets. The key distinction for senior care: Medicare covers medical care; Medicaid covers long-term custodial care for those who cannot afford it.

No. Medicare does not cover the cost of assisted living under any circumstances. It may cover medically necessary services provided to an assisted living resident — a physician visit, a home health nurse visit, a therapy session — but not the room, board, and personal care that constitute the assisted living stay. Families frequently discover this gap too late, having assumed Medicare would cover what it does not.

Medicare covers short-term skilled nursing care (up to 100 days per benefit period) following a qualifying three-night hospital stay. It does not cover long-term nursing home care. Once the need for skilled care ends or the 100 days is exhausted, Medicare coverage stops. Long-term nursing home care is covered by Medicaid for eligible individuals, or by private pay for those who do not qualify for Medicaid.

Texas Medicaid does not broadly cover assisted living. There are limited Medicaid waiver programs (STAR+PLUS) that can fund some home and community-based services for Medicaid-eligible individuals who might otherwise require nursing home care, but these are limited in scope and often have waitlists. Medicaid nursing home coverage is far more accessible and comprehensive than Medicaid assisted living coverage in Texas.

Medicare covers: people 65 and older who have worked and paid Medicare taxes for at least 10 years; people under 65 with certain disabilities who have received Social Security Disability Income for 24 months; and people with end-stage renal disease or ALS. Medicare is not income-based — it is based on age and work history. Premiums apply for Part B (outpatient) and Part D (prescription drugs).

Medicaid for nursing home care requires both financial eligibility (generally less than $2,000 in countable assets for a single person) and medical eligibility (needing nursing home level of care). Income is also considered. Texas uses the STAR+PLUS program for most Medicaid-covered long-term care. Eligibility rules are complex — an elder law attorney or benefits counselor can evaluate whether a specific individual qualifies.

Yes — people who qualify for both are called “dual eligible.” For nursing home residents, Medicare covers the skilled care portion of the stay (up to 100 days) and Medicaid covers the long-term custodial care that follows. For dual-eligible individuals, Medicare is primary and Medicaid supplements. Dual eligibility also provides significant cost savings on Medicare premiums, deductibles, and copays.

Medicare Part A covers: inpatient hospital care; skilled nursing facility care (up to 100 days after a qualifying hospital stay); hospice care; and some home health care. Most people do not pay a premium for Part A because they paid Medicare taxes while working. Part A is what most people think of when they think of hospital insurance.

Medicare Part B covers: outpatient medical services (physician visits, lab tests, imaging); preventive services (annual wellness visits, screenings); outpatient therapy; durable medical equipment (walkers, wheelchairs); and some home health care. Part B requires a monthly premium (approximately $174/month in 2026 for most beneficiaries) and has an annual deductible. Medigap supplemental plans can cover Part B cost-sharing.

Medigap (Medicare Supplement) plans are private insurance policies that pay some or all of the cost-sharing gaps in original Medicare — deductibles, copays, and coinsurance. For seniors who use a lot of healthcare, a Medigap plan can significantly reduce out-of-pocket costs. Medigap does NOT cover assisted living, long-term nursing home care, or prescription drugs. It supplements Medicare but does not fill the long-term care coverage gap.

Apply through Texas HHSC — online at yourtexasbenefits.com or in person at a local HHSC benefits office. The application requires extensive documentation of income, assets, and medical need. Many families work with an elder law attorney or a Medicaid specialist to complete the application accurately and avoid delays or denials. Processing typically takes 45 to 90 days.

Medicare coverage continues even after a person enters a nursing home on Medicaid. Medicare covers physician visits, hospitalizations, Part D prescription drugs, and any skilled care episodes (post-hospitalization SNF stays). Medicaid covers the nursing home room and board and custodial care costs. The two programs work together in a coordinated way for dual-eligible nursing home residents.