Medicare open enrollment 2026 for San Antonio seniors: what changes by Dec. 7, and what Medicare will and won't pay for assisted living or nursing care.
By San Antonio Senior Advisor Care Team · October 19, 2026
Medicare open enrollment 2026 for San Antonio seniors runs from October 15 through December 7, which means the window is already open as you read this. During this period, anyone with Medicare can switch between Original Medicare and a Medicare Advantage plan, change from one Medicare Advantage plan to another, or add, drop, or change a Part D prescription drug plan. Whatever you choose takes effect on January 1. For families in Bexar County, where many older adults rely on a combination of Medicare, a supplemental policy, and sometimes Medicaid or VA benefits, this is the one time each year when a poorly fitting plan can be corrected without penalty.
It helps to know that open enrollment is separate from the Medicare Advantage Open Enrollment Period, which runs January 1 through March 31 and is only for people already in a Medicare Advantage plan who want to switch to a different Medicare Advantage plan or return to Original Medicare. If you miss the fall window, your options in the spring are narrower. That is why families who are already thinking about assisted living or a nursing home for a parent should review coverage now, before a hospital stay or a move forces a rushed decision. Plan networks in San Antonio can differ sharply: a plan that includes Methodist Hospital, Baptist Medical Center, and UT Health physicians may not include every Christus Santa Rosa specialist or every home health agency your parent uses today.
The most common and costly misunderstanding we hear from San Antonio families is that Medicare pays for assisted living. It does not. Neither Original Medicare nor a standard Medicare Advantage plan covers what is called custodial care, meaning help with bathing, dressing, eating, toileting, medication reminders, and the room and board that make up the monthly bill at a Texas assisted living facility. Those facilities are licensed by the Texas Health and Human Services Commission under Chapter 247 of the Health and Safety Code, as Type A (residents who can evacuate on their own) or Type B (residents who need help evacuating, which includes most memory care), and the monthly fee is paid privately, through long-term care insurance, through VA benefits, or in limited cases through Medicaid.
What Medicare can still pay for while a person lives in assisted living is medical care delivered there. Doctor visits, Part B outpatient therapy, home health services ordered by a physician for someone who is homebound, hospice, durable medical equipment, and prescription drugs under Part D all continue to work the same way they would at home. Many San Antonio assisted living communities coordinate visiting physicians, podiatrists, and home health nurses so residents do not have to travel. The practical takeaway is to treat Medicare as the payer for medical needs and plan separately for the housing and daily-care portion, which is where the real cost sits.
Medicare does cover a limited stay in a skilled nursing facility, but only under specific conditions. Original Medicare Part A requires a qualifying inpatient hospital stay of at least three days, and the skilled nursing admission generally has to begin within 30 days of leaving the hospital for a condition related to that stay. Observation status does not count as inpatient, so families should ask the hospital case manager directly whether a parent has been formally admitted. Texas nursing homes are licensed under Chapter 242 of the Health and Safety Code, and you can look up inspection history through the HHSC provider disclosure system at apps.hhs.texas.gov/HSPubDisclosure.
When the conditions are met, Part A pays for days 1 through 20 in full, then requires a daily coinsurance for days 21 through 100, and nothing after day 100. The 2026 coinsurance amount is set by CMS each year, so confirm the current figure at medicare.gov. Coverage also ends when a person stops needing daily skilled care, even if days remain. Medicare Advantage plans must cover at least what Original Medicare covers, but many add prior authorization, require in-network facilities, and may end coverage sooner, which is why hospital discharge planners at Methodist, Baptist, and Christus Santa Rosa often ask which plan a patient has before proposing a rehab facility.
Neither option is automatically better, and the right answer depends on how your parent uses care. Original Medicare lets a person see any doctor or hospital that accepts Medicare nationwide, and it pairs with a Medigap supplement and a standalone Part D plan. Premiums are often higher, but out-of-pocket costs are more predictable. Medicare Advantage bundles coverage into one plan, often with low or zero premiums and extras such as dental, vision, and over-the-counter allowances, but with provider networks, referral rules, and a yearly out-of-pocket maximum. In San Antonio, where a large share of residents are Hispanic and many prefer a bilingual physician, check that the specific doctor and the Spanish-speaking clinic are in the plan network before you enroll.
Families planning for a possible move into assisted living or memory care should ask three questions of any plan: Is my parent's current primary care doctor in network? How does the plan handle skilled nursing authorization and how quickly? What happens to prescriptions if the pharmacy changes when a parent moves into a facility that uses a long-term care pharmacy? Medigap policies bought outside a person's first six months on Part B can require medical underwriting in Texas, so dropping a Medigap policy for Medicare Advantage can be difficult to reverse. That is a reason to compare carefully rather than switch only because of a mailer.
Start by gathering the facts: which plan your parent has now, what it will cost in 2026 according to the Annual Notice of Change the plan mails in the fall, and whether the doctors, hospitals, and pharmacy your parent depends on remain in network. Many San Antonio families discover only after January that a favorite clinic left a network, so read that notice carefully rather than setting it aside. If your parent has memory loss, make sure a trusted family member holds a signed medical power of attorney so someone can speak with the plan and with providers.
Next, match the plan to the care path you expect over the next year. If a hospital stay or rehab is likely, ask how the plan handles skilled nursing authorization. If a move to assisted living is under discussion, use the same weeks to tour communities, confirm each license through the HHSC provider disclosure site, and budget the monthly cost separately from Medicare. Writing down the questions and the answers from each plan and each tour makes the final decision far easier and keeps a stressful season manageable.
You do not have to decode this alone, and you should be cautious of unsolicited calls pushing a particular plan. The Alamo Area Council of Governments, which serves as the Area Agency on Aging for Bexar and surrounding counties, offers benefits counseling and can connect you with certified Medicare counselors through the Texas Health Information, Counseling and Advocacy Program, known as HICAP. You can reach AACOG at (210) 362-5200 or through aacog.com, and the Texas Health and Human Services site at hhs.texas.gov lists statewide counseling options. Counselors are unbiased, do not sell insurance, and can compare plans using your parent's actual medications and doctors.
Bring a current list of medications with dosages, the names of every doctor and pharmacy your parent uses, the Medicare card, and any Medicaid or VA paperwork. Veterans should also ask the Audie L. Murphy VA Medical Center or the Texas Veterans Commission at tvc.texas.gov how VA benefits coordinate with Medicare, since some veterans use both. If your parent may eventually qualify for the Texas Medicaid STAR+PLUS Home and Community Based Services waiver, mention that too, because Medicaid eligibility interacts with Medicare supplement and Part D choices, including Extra Help with prescription costs.
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