
Medicare vs Medicaid for Long-Term Care
What's the Difference for Texas Seniors?

TL;DR: Medicare is health insurance for disabled people 65 and older; it covers hospital care, doctors, and short rehab stays up to 100 days.
Medicaid is a needs-based program that pays for ongoing nursing home and community care once you qualify financially. Long-term care is paid by Medicaid, not Medicare. (Click here to learn more about long-term Care)
The single most expensive misunderstanding in elder care is one word: families believe Medicare will cover the nursing home.
Then day 101 arrives, Medicare stops, and the bill lands on the family.
I want you to see this gap years before it reaches you. Medicaid will limit the value of countable assets.
There are special rules for both individuals and married couples to preserve countable assets.
What Does Medicare Actually Cover?
- Hospital stays, physician care, and prescriptions under its various parts
- Skilled nursing and rehab after a qualifying hospital stay: fully covered days are limited, with copays after day 20, ending at day 100
- Home health in limited, skilled circumstances
- Not covered: ongoing custodial care, meaning help with bathing, dressing, eating, and supervision for dementia
What Does Medicaid Cover in Texas?
- Ongoing nursing home care for as long as it is medically necessary
- Community-based waiver programs like STAR+PLUS that support care at home
- Coverage begins only after you meet strict income and asset limits
- Texas is an income cap state; a Miller trust (qualified income trust) solves an over-the-cap income problem
The 5 Differences That Matter Most
- Who qualifies: Medicare by age or disability; Medicaid by financial and medical need.
- What it pays: Medicare pays for recovery; Medicaid pays for care that never ends
- Time limits: Medicare rehab stops at 100 days; Medicaid has none
- Your assets: Medicare ignores them; Medicaid computes countable assets above $2,000 for a single person, married couples get to keep more countable assets.
- Your estate: Medicare makes no claim; Texas Medicaid may seek estate recovery after death (Click here to learn more about medicaid estate recovery)
The Gap Between Them Is Where Families
Lose Everything
The planning gap is the period after Medicare rehab ends and before Medicaid eligibility begins, when families pay $6,000 to $9,000 per month out of pocket. Elder law planning exists to shrink that gap: protecting the healthy spouse, preserving the homestead, and using legal tools to reach eligibility without losing everything first.

FAQ
Q: Does Medicare cover nursing home care?
A: Only short-term rehabilitation after a hospital stay, up to 100 days. It never pays for ongoing custodial nursing home care.
Q: Can you have Medicare and Medicaid at the same time in Texas?
A: Yes. Dual-eligible seniors keep Medicare for medical care and use Medicaid for long-term care and cost-sharing help.
Q: What is a Miller trust in Texas?
A: A Miller trust, or Qualified Income Trust, holds income above the Texas Medicaid cap so a person who is otherwise eligible can qualify for nursing home benefits.
Q: How do I qualify for Medicaid long-term care in Texas?
A: You must need nursing-facility-level medical care and meet income and asset limits. An elder law attorney can often achieve eligibility legally while protecting a spouse and the home.
If a hospital discharge planner has ever said the words "Medicare days are ending," call us immediately: 713-529-5900. We help Houston families close the gap.




