El Paso Senior AdvisorDoes Medicare pay for assisted living in El Paso?
No. Medicare does not pay for assisted living rent, meals or personal care, and it does not pay for long-term custodial care in a nursing facility; it pays for medical care, including doctor visits, hospital stays, short-term skilled rehab, home health and hospice.
Residents of El Paso assisted living keep their Medicare coverage for medical services delivered there, such as home health visits, therapy and hospice. Long-term care itself is paid privately, through long-term care insurance, VA benefits, STAR+PLUS or PACE.
How much nursing home rehab does Medicare cover?
After a qualifying inpatient hospital stay of at least three days, Medicare Part A can cover up to 100 days of skilled nursing facility care per benefit period, paying in full for the first 20 days and charging a daily coinsurance from day 21 to day 100, as long as the patient needs and improves with skilled care.
Observation days in the hospital do not count toward the three days, so ask the El Paso hospital whether your parent is admitted as an inpatient. Medicare Advantage plans set their own rules and often require prior authorization for a rehab stay; call the plan before discharge. When skilled care ends, the nursing facility will give written notice and the bill shifts to another payer.
Does Medicare pay for home health in El Paso?
Yes, for a homebound patient under a physician's plan who needs intermittent skilled nursing or therapy, Medicare covers home health visits from a Medicare-certified agency with no copay, including some aide visits tied to that skilled care.
Medicare home health is not hourly caregiving; visits are typically an hour or less, a few times a week. HHSC's directory shows 93 home health agencies and 43 hospice agencies with offices in El Paso County, plus 108 agencies licensed only for personal assistance services. Our roster shows which El Paso agencies are licensed and certified for home health, the certification needed to bill Medicare.
Does Medicare pay for hospice in El Paso?
Yes. Medicare's hospice benefit covers comfort-focused care for someone whose doctor certifies a life expectancy of six months or less if the illness runs its usual course, including nursing visits, aides, social work, chaplaincy, medications and equipment related to the terminal illness.
Hospice can be provided at home, in assisted living or in a nursing facility, but Medicare does not pay room and board in a facility. HHSC lists 43 licensed hospice agencies with offices in El Paso County; hospices headquartered elsewhere can also serve El Paso addresses. You choose the hospice; ask how quickly a nurse can come at night and on weekends.
Where can El Paso families get free Medicare counseling?
HICAP, the Health Information, Counseling and Advocacy Program, gives free, unbiased Medicare counseling in Texas at 1-800-252-9240, and the Rio Grande Area Agency on Aging's benefits counselors help El Paso residents at (915) 533-0998.
Counselors can compare Medicare Advantage and supplement plans, check prescription coverage, screen for the Medicare Savings Programs and Extra Help, and explain appeal rights when a rehab stay is ending. Open enrollment runs October 15 to December 7 each year.
Side by side
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Rehab | Up to 100 days of skilled nursing after a qualifying stay | Long-term custodial nursing home care |
| Home | Intermittent skilled home health visits | Hourly personal care or companions |
| End of life | Hospice care and related medications | Room and board in a facility |
| Housing | Medical care delivered in assisted living | Assisted living rent or meals |
Sources: Texas Health and Safety Code chapters 142, 242 and 247; 26 Texas Administrative Code chapters 553, 554, 558 and 559; HHSC program handbooks; CareScout, CMS and VA rate tables, as cited above. See our editorial standards.
