If you or a loved one needs in-home care, understanding your coverage options can be overwhelming. Two of the most common programs—Medicaid and Medicare—offer different types of support. However, many families don’t realize that these two programs have very different eligibility requirements and benefits. This guide compares Medicaid vs. Medicare home care in Texas so you can confidently choose the best fit for your needs
Medicare Home Care Coverage in Texas
Medicare is a federal insurance program for:
- Adults 65 and older
- Individuals with disabilities
- Those with End-Stage Renal Disease (ESRD)
✅ What Medicare Covers:
- Intermittent skilled nursing care
- Physical, occupational, and speech therapy
- Medical social services
- Limited home health aide services (must be tied to skilled care)
❌ Medicare does not cover long-term personal care or 24/7 supervision.
📝 Medicare Eligibility:
- Doctor certification required
- Must be homebound
- Must use a Medicare-certified home health agency
Medicaid Home Care Coverage in Texas
Medicaid is a joint state and federal program based on income. It’s designed to help low-income individuals of all ages, including seniors and people with disabilities.
✅ What Medicaid Covers:
- Personal care assistance (bathing, grooming, dressing)
- Home health and nursing care
- Therapy and transportation (in some cases)
- Respite care and attendant services
Programs include:
- Primary Home Care (PHC)
- Community Attendant Services (CAS)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
📝 Medicaid Eligibility:
- Texas residency
- U.S. citizen or legal resident
- Income limit: usually under $2,829/month for individuals (2025)
- Asset limit: generally under $2,000
- Must meet medical need criteria
👉 Apply through YourTexasBenefits.com
Which Is Better? Medicaid vs. Medicare Home Care Texas Comparison
Let’s compare side-by-side
| Feature | Medicare | Medicaid (Texas) |
| Eligibility | 65+, disability, ESRD | Income-based, all ages |
| Covers Personal Care? | ❌Limited (only tied to skilled care) | ✅Yes |
| Covers Skilled Nursing? | ✅Yes (intermittent, short-term) | ✅Yes |
| Covers Long-Term Care? | ❌No | ✅Yes |
| Requires Doctor Approval? | ✅Yes | ✅Yes (or HHSC assessment) |
| Administered By | Federal (CMS) | State (HHSC – Texas Health and Human Services) |
Can You Have Both?
Yes! Some individuals qualify for both Medicare and Medicaid, called dual eligibility. In these cases:
- Medicare pays first for approved services
- Medicaid covers what Medicare doesn’t (like long-term personal care)
As a result, dual-eligible individuals can access broader support at little or no cost.
Want More Help Understanding Medicaid?
If you’re considering Medicaid for home care, read this helpful post next:
➡️ How to Qualify for Medicaid Home Care in Texas
Final Thoughts
Understanding the difference between Medicaid vs. Medicare home care in Texas is key to making the right choice for your family. While Medicare helps with short-term skilled care, Medicaid offers essential long-term support for eligible individuals. Knowing your options helps ensure your loved one gets the right care at the right time.
✅ Still have questions about Medicaid or Medicare home care coverage?
Insignia Home Care Solutions is here to help.
📧 admin@insigniahcs.com | ☎️ 866-805-6868
