Houston Estate Planning and Elder Law Attorney Blog
Medicare’s annual enrollment period opens on October 15, and for Texas families managing a parent’s coverage it arrives with a mailbox full of plan comparisons. Where that parent is already in a nursing home, or likely to need one soon, the decision carries a cost that the plan brochures do not describe. The choice made before December 7 governs the parent’s medical coverage for the following year and can close off supplemental coverage later.
Medicare Open Enrollment in Texas runs from October 15 through December 7, and changes take effect January 1. It lets a beneficiary move between Original Medicare and a Medicare Advantage plan and change drug coverage. It does not change the federal rule barring Part A and Part B payment for long-term custodial care. McCulloch & Miller advises families across Houston and Texas on Texas elder law questions like this one, where a medical decision and a long-term care cost arrive in the same season.
What Medicare Open Enrollment Allows a Texas Beneficiary to Change
Medicare Open Enrollment is the annual period from October 15 through December 7 during which a Medicare beneficiary may change how they receive Medicare coverage for the next calendar year.
According to Medicare’s own enrollment guidance, three kinds of change are available during the window:
- Switching coverage types: moving from Original Medicare to a Medicare Advantage plan, or from a Medicare Advantage plan back to Original Medicare.
- Changing Advantage plans: joining, dropping, or switching to another Medicare Advantage plan, with or without drug coverage.
- Changing drug coverage: joining, dropping, or switching a Medicare drug plan for someone in Original Medicare.
The plan must receive the request by December 7. A change made on the last day still takes effect January 1, the same as one made in October.
Why Original Medicare Does Not Pay for Custodial Nursing Home Care
Families often approach the enrollment decision hoping to find a plan that will cover a parent’s nursing home stay. Under 42 U.S.C. § 1395y(a)(9), no payment may be made under Part A or Part B for expenses for custodial care. Custodial care means help with bathing, dressing, eating, and supervision, which is the help most long-term residents actually receive.
What Original Medicare does cover is short-term skilled care. Its skilled nursing facility benefit follows an inpatient hospital stay of at least three consecutive days and runs up to 100 days per spell of illness. It pays for skilled care, not custodial help. The firm has written separately about how that benefit ends.
Anyone weighing a Medicare Advantage plan for a parent in facility care should ask the plan directly how it handles a skilled nursing stay and get the answer in writing, since each plan publishes its own terms. Long-term custodial care is generally paid privately, through long-term care insurance, or through Texas Medicaid, which is where McCulloch & Miller’s Medicaid crisis planning work begins.
If that describes your situation, call McCulloch & Miller at (713) 333-8900 to set up a time to talk.
The Medigap Problem With Leaving Medicare Advantage in December
A parent who leaves a Medicare Advantage plan for Original Medicare usually wants a Medicare Supplement policy, called Medigap, to cover what Original Medicare leaves unpaid. The timing rules for buying one are stricter than the enrollment window suggests.
Medigap Open Enrollment is the six-month period that starts the first day of the month a person is 65 or older and enrolled in Part B. Outside it, Medicare states that there is no federal guarantee an insurance company will sell a Medigap policy, and a policy that is available may cost more because of past or present health problems. A parent in declining health who switches back to Original Medicare in December may find that no supplement is available at a workable price.
The same rule runs the other direction. A parent who drops an existing Medigap policy to join an Advantage plan should not assume the policy can be bought back later on the same terms.
When Texas Medicaid Starts, the Calendar Can Change
Enrollment periods are not limited to the fall. Medicare lists getting Medicaid among the life events that can open a Special Enrollment Period, so a parent who qualifies for Texas Medicaid partway through the year may be able to change plans without waiting for October.
That makes the order of decisions worth planning. A family expecting to pursue Medicaid for nursing home care in the coming months may reasonably hold off on a major coverage change in the fall and revisit it once eligibility is settled.
Questions Texas Families Ask During Medicare Open Enrollment
Can a Change Made in November Be Undone in January?
A parent who is already in a Medicare Advantage plan on January 1 can use the Medicare Advantage Open Enrollment Period, January 1 through March 31, to switch to a different Advantage plan or return to Original Medicare. The Medigap limits described above still apply to a return.
Does Original Medicare Pay for Assisted Living?
No. Assisted living is custodial care, and 42 U.S.C. § 1395y(a)(9) bars Part A and Part B payment for custodial care. A family considering a Medicare Advantage plan should ask the plan what, if anything, it offers beyond that and get the answer in writing.
What Is the Last Day to Make a Change for Next Year?
December 7. The plan must receive the enrollment request by that date for the change to take effect on January 1.
Planning Around the December 7 Deadline
A parent’s Medicare choices and a parent’s long-term care costs are separate questions answered under separate programs, and the families who handle this season well treat them that way. Coordinating public benefits planning with the coverage decisions that come due each fall is a regular part of the firm’s elder law work. McCulloch & Miller works with families in Houston and across Texas. Call (713) 333-8900 or contact the firm to arrange a consultation.