The short answer: No. Medicare does not cover the monthly room-and-board or personal care costs of assisted living. This surprises many Houston families who assume Medicare — the federal health insurance program for Americans 65 and older — works like a comprehensive senior benefit. Understanding what Medicare does and does not cover is essential before finalizing any care plan.

What Medicare Does NOT Cover in Assisted Living

Medicare explicitly excludes coverage for:

  • Monthly assisted living fees — room and board, meals, housekeeping, social activities
  • Personal care assistance — bathing, dressing, grooming, incontinence care, mobility assistance
  • Medication management as provided by the ALF (reminders, administration)
  • Long-term residential care of any kind — Medicare was designed for acute medical care, not ongoing personal care
Important: Medicare's exclusion of assisted living room-and-board costs is permanent and by design — not a gap that will be filled by policy changes. Families who plan to rely on Medicare for long-term assisted living costs will face a financial crisis. Planning must begin with this reality as the foundation.

What Medicare DOES Cover in an Assisted Living Setting

While Medicare won't pay the ALF's monthly bill, it can cover specific medical services delivered to a resident who remains enrolled in Medicare Parts A and B:

  • Medicare Part B (outpatient): Physical therapy, occupational therapy, and speech therapy provided by a certified home health agency that visits the ALF. Also covers physician visits if the doctor comes to the community.
  • Medicare Part B: Durable medical equipment (wheelchairs, walkers, hospital beds) ordered by a physician for use in the ALF
  • Medicare Part D: Prescription drug coverage — Medicare drug plans (Part D) remain in effect regardless of where a senior lives, including in assisted living
  • Medicare Part A (skilled nursing benefit): If a resident is hospitalized for a qualifying stay (3+ inpatient nights) and then requires skilled rehabilitation, Medicare Part A may cover a short-term stay at a separate skilled nursing facility (SNF) — not the ALF itself — for up to 100 days
  • Medicare Advantage plans may offer additional benefits not available in traditional Medicare, such as transportation, dental, or vision — but still do not cover ALF room-and-board costs

Texas Medicaid: The STAR+PLUS Waiver

Texas offers Medicaid coverage for some assisted living costs through the STAR+PLUS Home and Community-Based Services (HCBS) Waiver, administered by the Texas Health and Human Services Commission (HHSC). This is the primary public funding pathway for assisted living in Texas for income-eligible seniors.

STAR+PLUS can cover:

  • Personal attendant care services in an ALF
  • Some habilitation and day activity services
  • Transition services when moving from a nursing facility to community care

STAR+PLUS does not typically cover room-and-board costs (housing and meals) — the resident or family must pay those directly.

Who Qualifies for STAR+PLUS in Texas?

To qualify for the STAR+PLUS HCBS waiver in Texas, a senior must meet all of the following criteria:

  • Age 65+, or have a qualifying disability of any age
  • Income: At or below 300% of the Federal Benefit Rate (approximately $2,742/month for a single individual in 2025)
  • Assets: Countable assets at or below $2,000 for an individual (with exceptions for a primary home, one vehicle, and certain exempt assets)
  • Functional need: Require a nursing facility level of care — meaning a clinical assessment confirms significant daily care needs
  • Residency: Texas resident with U.S. citizenship or qualified immigration status

How to Apply for STAR+PLUS in Texas

  1. Contact your local HHSC benefits office or call 2-1-1 (Texas Health and Human Services helpline) to start an application
  2. Complete a Medicaid eligibility application through YourTexasBenefits.com or in person at an HHSC office
  3. HHSC conducts a functional needs assessment to determine whether you qualify for a nursing facility level of care
  4. If financially and functionally eligible, you are enrolled in STAR+PLUS managed care and assigned to a health plan (Amerigroup, Molina, United Healthcare, or similar)
  5. Your STAR+PLUS plan works with you to identify participating ALFs in your area of Houston that accept Medicaid

The Waitlist Reality in Houston

STAR+PLUS HCBS waiver slots are limited. In the Houston area, waitlists of 6 months to 2+ years are not uncommon for HCBS community care services. This is a hard reality for families in financial need of immediate assistance.

Practical steps while waiting:

  • Apply immediately — the clock doesn't start until the application is submitted
  • Ask the HHSC caseworker about interest lists — being on a list preserves your place
  • Consider whether the senior might qualify for a nursing facility temporarily while waiting for HCBS availability (nursing facility Medicaid has different availability)
  • Explore bridge financing — short-term loans against life insurance or real estate to cover the private-pay gap while awaiting Medicaid approval

Other Ways to Pay for Assisted Living

For the majority of Houston families who don't qualify for Medicaid or face a waitlist, the realistic payment options include:

  • Private pay (personal savings): The most common funding source. Social Security, pension income, and investment distributions cover costs for many seniors in early years of assisted living.
  • Long-term care insurance: Policies purchased in advance that pay a daily benefit for assisted living care. Benefits typically activate after a 90-day "elimination period." Increasingly rare in new policy issuance but still valuable for those who have them.
  • VA Aid and Attendance: Veterans and surviving spouses who served during wartime may qualify for the VA's Aid and Attendance pension benefit — up to $2,727/month for a veteran and spouse in 2025. This is significantly underutilized in the Houston area. VA benefits guide for Texas seniors
  • Life insurance conversion: Policies with cash value can be surrendered or converted through a Life Settlement to generate funds for care.
  • Reverse mortgage: For homeowners 62+, a Home Equity Conversion Mortgage (HECM) can generate proceeds to fund assisted living costs — with the home remaining in the estate.