The Short Answer
Medicare does NOT pay for long-term personal care (bathing, dressing, meal prep, medication reminders). Medicaid — specifically STAR+PLUS in Texas — does. These two programs are fundamentally different in what they were designed to cover.
What Medicare Covers
Medicare is federal health insurance for people 65 and older (and some younger people with disabilities). It covers medical care: doctor visits, hospital stays, skilled nursing (limited), home health services (limited), and hospice. The key word is 'skilled' — Medicare pays for a nurse to come assess a wound, or a physical therapist to help after a hip replacement. Once the skilled need ends, Medicare coverage ends. It does not pay for an ongoing caregiver to help with daily activities.
What Medicaid (STAR+PLUS) Covers
Medicaid is a state-federal program for people with low income and assets. In Texas, STAR+PLUS Medicaid covers Personal Assistance Services (PAS) — the daily help that Medicare specifically excludes: bathing, dressing, grooming, transfers, meal preparation, medication reminders, light housekeeping, and companion care. For people who meet the nursing facility level of care standard, the STAR+PLUS HCBS Waiver also covers respite care, adaptive aids, and more — often for many hours per week or per day.
The Most Common Scenario
A family member has a stroke or hip replacement. Medicare pays for the hospital stay and a short-term home health rehab period (maybe 20–30 visits from a skilled nurse or therapist). Once the patient is 'stable,' Medicare stops. But the patient still needs daily help — they can't bathe alone, can't cook, can't transfer safely. This is when families realize Medicare wasn't designed for this — and start looking for alternatives.
What Are the Alternatives?
- STAR+PLUS Medicaid (Texas) — For adults 21+ who meet nursing facility level of care and are Medicaid-eligible. No cost to the family for authorized services. This is the primary payer for most of our clients in Cameron County.
- PHC — Primary Home Care — For Medicaid clients not on a managed care plan. Basic PAS through HHSC contract.
- Driscoll Health Plan — CHIP and Medicaid STAR managed care plan for eligible children and families in South Texas. We are an accepted in-network provider.
- Long-Term Care Insurance — If your family member purchased this policy before needing care, it may cover personal assistance services. We bill directly to most major LTC insurers.
- Private Pay — For families who do not qualify for public programs. Local Brownsville/Cameron County market rate is approximately $13–$25/hour depending on service level.
How to Find Out What Your Loved One Qualifies For
The fastest way is to call us at (956) 594-8188. We help families in Cameron County navigate these programs every day, at no cost. Tell us your loved one's situation, their insurance status, and their care needs — we'll guide you to the right program and help you start the application process. There's no commitment and no fee for the guidance.