Community Corner
Medicare Open Enrollment Won't Pay for a Nursing Home
Open enrollment runs Oct. 15 to Dec. 7. Houston elder law attorney Kim Hegwood on the coverage gap families find out about too late.
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Medicare's annual open enrollment period runs from October 15 through December 7, 2026, and any change made in that window takes effect January 1, 2027. Roughly 68 million Americans use it as their once-a-year chance to switch plans, add drug coverage, or move between Original Medicare and Medicare Advantage. Across Clear Lake, Sugar Land, Katy, and the Galleria, mailboxes have been filling with plan comparisons since the start of the month.
Kim Hegwood has watched that annual ritual for more than 25 years, and she says the comparisons almost never address the expense that does the most damage to a Texas family's finances. Hegwood is the founding attorney of Your Legacy Legal Care®, a Greater Houston elder law and estate planning firm recognized by the Houston Chronicle as Best Trust & Estate Law Firm.
"People spend three weeks comparing drug formularies and then call us in March because Mom is being discharged to a nursing home and nobody will pay for it," Hegwood said. "There is no plan on that comparison chart that solves the problem they are actually about to have."
Medicare does not pay for nursing homes in Texas, or in any state, except for a short period following a hospital stay. That coverage only applies when the nursing home admission follows an inpatient hospital stay of at least three days, not counting the discharge day, and it stops after 100 days.
The distinction that matters is between skilled care and custodial care. Rehabilitation after a stroke or a broken hip is skilled. Help with bathing, dressing, eating, and supervision for someone with dementia is custodial, and custodial care is what most families end up needing for years rather than weeks. The cost is substantial. As of December 2025, a private room in a Texas nursing home averaged roughly $7,300 a month, or close to $88,000 a year.
For long-term custodial care, the payer is Medicaid, and the rules are nothing like Medicare's. To qualify for nursing facility or waiver coverage in Texas in 2026, countable income must be at or below $2,982 a month, countable resources at or below $2,000 for a single applicant, and the applicant must meet a nursing facility level of care. The home equity limit sits at $752,000.
Being over the income cap is not disqualifying by itself. An applicant above the limit can still qualify by diverting the excess into a Qualified Income Trust, sometimes called a Miller Trust. Being over the asset limit is a different problem, and it is the one Hegwood says families handle worst on their own.
"The instinct is to start giving things away. Deed the house to a child, move money to the grandkids," she said. "Medicaid looks back five years at every transfer, and gifts made in that window create a penalty period where nobody pays the bill. Families create the crisis they were trying to avoid."
Her team handles that work as Medicaid planning and long-term care planning, and the firm prices both on a flat fee rather than hourly.
Hegwood's suggestion is practical. Families already sitting down with plan documents in October should use the same afternoon for the documents Medicare has nothing to do with.
A statutory durable power of attorney and a medical power of attorney are first on her list, and the timing is not flexible. Texas requires capacity to sign one, which means the window closes as a dementia diagnosis progresses. Without those documents, a family facing a medical emergency has to petition a court for guardianship, a process that takes months and costs thousands.
Beneficiary designations come next. Retirement accounts and life insurance pass by designation rather than by will, and Hegwood says ex-spouses and deceased relatives still appear on forms her team reviews every week.
Homestead real estate gets its own treatment. In Texas, a Lady Bird deed, also called an enhanced life estate deed, can move a homestead to the next generation at death while the owner keeps full control during life. Her firm uses that approach rather than direct retitling for homestead property.
For families already past the planning stage, with a parent in the hospital or a nursing home admission scheduled, the work shifts to Medicaid crisis planning. Hegwood said more can usually be protected at that point than people assume, though the options narrow by the week.
"The families who do best are not the wealthiest ones," she said. "They are the ones who had a conversation before anything went wrong. December 7 is a real deadline for your drug plan. The other deadline is the one nobody puts on the calendar, and it is whenever your health changes."
About Your Legacy Legal Care®
Your Legacy Legal Care® is a Greater Houston elder law and estate planning firm founded in 1998 by Kim Hegwood. The firm handles estate planning, trusts and wills, Medicaid and long-term care planning, asset protection, special needs planning, guardianship, and probate, and was named Best Trust & Estate Law Firm by the Houston Chronicle. The team works from offices in Clear Lake, the Galleria, Katy, Sugar Land, and Bay City, serving families across the Greater Houston area. Estate planning and Medicaid planning are offered on a flat fee. Strategy sessions are complimentary.
To learn more, visit yourlegacylegalcare.com.
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