Does Medicare pay for assisted living in San Antonio, Texas in 2026? What Part A, Part B and Medicaid STAR+PLUS actually cover, and what they do not.
By San Antonio Senior Advisor Care Team · October 10, 2026
The short answer for families in Bexar County is no: Original Medicare does not pay for assisted living in San Antonio, Texas, and it does not pay for the monthly room, board, and personal care that make up most of an assisted living bill. Medicare is health insurance, built to cover medical care that is considered medically necessary, such as hospital stays, doctor visits, and limited, short-term skilled nursing care after a qualifying hospitalization. Assisted living, which Texas licenses under Chapter 247 of the Health and Safety Code, is classed as custodial care: help with bathing, dressing, medication reminders, meals, and supervision. Medicare does not cover custodial care when it is the only care a person needs, whether the setting is a Type A or Type B assisted living community in Stone Oak, Alamo Heights, or anywhere else in the region.
That surprises many families we hear from, especially when a parent has just been discharged from Methodist Hospital, Baptist Medical Center, or University Hospital and a case manager says the next step is a facility. Because the hospital stay was covered, people assume the next stop will be covered too. In practice, the answer depends on whether the next stop is a Medicare-certified skilled nursing facility for rehabilitation, or an assisted living community for ongoing daily help. The first can be partly covered for a limited time; the second is paid privately, through long-term care insurance, through VA benefits for eligible veterans, or, for people who qualify financially and medically, through the Texas Medicaid STAR+PLUS HCBS program, which pays for services rather than rent.
Medicare Part A can pay for a stay in a Medicare-certified skilled nursing facility, but only under specific conditions. The person must have had a qualifying inpatient hospital stay of at least three days, which counts days formally admitted as an inpatient and not days in observation status. They must enter the skilled nursing facility within a short window after leaving the hospital, and a doctor must certify that they need daily skilled care such as physical therapy, wound care, or skilled nursing. When those conditions are met, Medicare covers the first 20 days in full, and days 21 through 100 carry a daily coinsurance, which in 2026 is $217 per day unless a supplement policy pays it. After day 100, Medicare coverage ends for that benefit period.
Part B covers outpatient services that sometimes accompany a move into assisted living: doctor visits, outpatient therapy, durable medical equipment, and medically necessary home health visits ordered by a physician. A resident in an assisted living community can still receive Medicare-covered home health or hospice services from a licensed agency coming to the building, but the assisted living charges themselves remain private-pay. Families sometimes ask whether a Medicare Advantage plan changes this. Most Advantage plans follow the same custodial-care exclusion, although some offer limited extra benefits such as a few meals after discharge or a transportation allowance. Always read your plan's Evidence of Coverage, and confirm with the plan before assuming any benefit applies.
If Medicare will not pay for assisted living, the next question is usually whether Texas Medicaid will. Medicaid is a different program with different rules, and it is the largest public payer of long-term care in the country. In Texas, Medicaid long-term services are delivered mainly through the STAR+PLUS managed care program, administered by Texas Health and Human Services (HHSC). Through the STAR+PLUS Home and Community-Based Services (HCBS) waiver, eligible adults can receive personal attendant services and other supports in a licensed assisted living community. The important detail is that Medicaid does not cover the room-and-board portion of assisted living; the resident generally pays that from their own income, so many families find the waiver helps most when a parent has a modest but steady income.
To qualify, an applicant generally must be 65 or older (or have a qualifying disability), meet the medical necessity standard for nursing-facility level of care, and fall under Medicaid's income and asset limits. Texas also applies a 60-month look-back on asset transfers, so gifting money or property to children in the five years before applying can trigger a penalty period. Demand for the waiver is high, and applicants are often placed on an interest list before services start; the AACOG Area Agency on Aging at (210) 362-5200 and the HHSC benefits line can explain where to sign up. In the San Antonio area, the Medicaid managed care plans include Molina Healthcare, Superior HealthPlan (Centene), UnitedHealthcare, and Amerigroup, and the plan assigned to your parent coordinates the service coordinator who builds the care plan.
Since neither Medicare nor, in most cases, Medicaid covers the full bill, families piece together funding. Many pay from retirement income, Social Security, pension payments, and savings, and some sell a home in neighborhoods such as Alamo Heights, Castle Hills, or Windcrest to fund several years of care. Others use a long-term care insurance policy, which may pay a daily or monthly benefit toward assisted living once the policyholder cannot perform two or more activities of daily living or has cognitive impairment. If your parent has a policy, call the insurer early, because most require a waiting period and documentation before benefits begin.
Veterans and surviving spouses should look at VA Aid and Attendance, a pension supplement that can help with the cost of assisted living for wartime veterans who meet service, medical, and financial criteria. San Antonio is home to Joint Base San Antonio, Brooke Army Medical Center, and the Audie L. Murphy VA Medical Center, so a large number of local families may qualify, yet many never apply. The Texas Veterans Commission (tvc.texas.gov) offers free help with claims. For families who do not qualify for these, a Medicare-covered rehab stay followed by a planned transition to a private-pay community, with a clear budget and a back-up plan, is often the most realistic path. Our assisted living cost guide for San Antonio gives current monthly ranges so you can plan ahead.
Before signing any assisted living contract, ask a neutral counselor to review your parent's coverage. Texas offers the Health Information, Counseling and Advocacy Program (HICAP) through the Area Agencies on Aging, and in our region that means AACOG, whose benefits counselors can explain Medicare, Medigap, Advantage plans, and Medicare Savings Programs at no cost. You can reach AACOG at (210) 362-5200 or through aacog.com. Medicare itself can be reached at 1-800-MEDICARE (1-800-633-4227), and Texas Health and Human Services provides information on Medicaid and long-term care at hhs.texas.gov. These sources are free, and they have no stake in which facility you choose.
It is also worth checking the community's record before you commit. HHSC publishes inspection and complaint information for licensed assisted living facilities and nursing facilities in its public disclosure system at apps.hhs.texas.gov/HSPubDisclosure, and a license should show whether a facility is Type A or Type B, which matters if your parent may need evacuation assistance or memory care. Ask each community what services are included in the base rate, how level-of-care increases are billed, and whether they accept Medicaid STAR+PLUS HCBS residents. Many Spanish-speaking families in San Antonio also prefer bilingual staff, so ask whether personal care aides and nurses speak Spanish. Asking these questions before a hospital discharge deadline, not during it, gives your family time to compare options without pressure.
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