By Penny Jones August 31, 2026
TL;DR: Texas families pay for long-term care in seven main ways: personal savings, long-term care insurance, hybrid life insurance policies, VA Aid and Attendance, home equity, family caregiving agreements, and Medicaid long-term care benefits. Most families end up combining two or three, and Medicaid planning protects the rest. Every week, a family sits in my office and asks the same question: how are we supposed to pay for this? A parent needs care, the numbers feel impossible, and nobody planned for it. Here is the honest answer, option by option, so you can see the full menu before you spend down a lifetime of savings. 1. Personal Savings and Retirement Income The default plan for most families, and the fastest to run out Nursing home care in the Houston area commonly runs $6,000 to $9,000 per month Works best as a bridge while you set up the smarter options below Home care can cost much more! 2. Long-Term Care Insurance Excellent if purchased in your 50s or early 60s; expensive or unavailable after health changes Check existing policies for elimination periods, daily benefit caps, and inflation riders Already own a policy? Bring it to your planning meeting; it changes the whole strategy 3. Hybrid Life Insurance With Care Riders Life insurance policies that let you spend the death benefit on care while living Popular because unused benefits still pass to your family Underwriting is easier than traditional long-term care insurance 4. VA Aid and Attendance A pension enhancement for wartime veterans and surviving spouses who need help with daily living Often missed: many Houston families never learn their parent qualifies Can stack with other strategies on this list 5. Home Equity Reverse mortgages and sale proceeds can fund care, with real tradeoffs In Texas, your homestead receives special protection in Medicaid planning; selling it at the wrong time can create problems Talk to an elder law attorney before touching home equity for care costs 6. Family Caregiving Agreements A written, paid caregiver contract with an adult child keeps money in the family Done correctly, payments are legitimate and Medicaid compliant Done informally, the same payments can look like gifts and trigger penalties later 7. Medicaid Long Term Care Benefits The payer of last resort for most families, and the one that requires the most planning Texas has strict income and asset limits, a five-year lookback on gifts, and estate recovery rules Tools like Miller trusts for income and spousal protections exist, and they work best before a crisis Which Option Is Best for Your Family? The best way to pay for long-term care in Texas is a layered plan: insurance or VA benefits where available, careful use of savings, and early Medicaid planning to protect the healthy spouse and the family home. The worst plan is writing checks until the money is gone. That is the plan most families are on by default. FAQ How much does a nursing home cost in Houston? Most Houston-area nursing homes cost between $6,000 and $9,000 per month, and memory care often costs more. Costs rise every year. Does Medicare pay for long-term care in Texas? No. Medicare covers up to 100 days of skilled rehabilitation after a hospital stay. It does not pay for ongoing custodial nursing home care or for ongoing custodial care at home. Can Medicaid take your house in Texas? The Texas homestead is generally protected during your lifetime, and the state may file an estate recovery claim after death. Planning ahead can protect the home for your family. When should I start Medicaid planning in Texas? Five years before you need care is ideal because of the lookback period. Planning is still possible in a crisis; the earlier you start, the more you protect. Every family's situation is different. Come see us at our Kirby Drive office or virtually, and we will map the options together. Call 713-529-5900. Law Office of Christina Lesher, PC, 5615 Kirby Dr, Suite 412, Houston, TX 77005.
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Medicare vs Medicaid for Long-Term Care

Penny Jones • September 17, 2026

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.



To access our Elder Law resources, click here.

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.


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