A clear, current breakdown of assisted living, memory care, in-home, and skilled nursing costs across San Antonio — from Stone Oak to the South Side — and the programs that lower the bill.
By Rosa Martínez, CSA · May 15, 2026
In Bexar County, assisted living (licensed as a Type A or Type B Assisted Living Facility, or ALF, under Texas Hum. Res. Code Ch. 247) typically runs $2,800–$4,500 a month for a Type A facility. Type B ALFs — which serve higher-acuity residents who need evacuation assistance and include most memory care — run $4,200–$6,800. Skilled nursing facilities licensed under Texas Health & Safety Code Ch. 242 average $7,500–$11,000 for a private room. In-home care through a licensed home health agency runs roughly $22–$35 an hour.
Geography matters within the metro. Stone Oak, Alamo Heights, and the Far North Side run 10–18% above the county median on comparable assisted living. The South Side, West Side, and Converse tend to run 8–14% below. New Braunfels and Boerne sit near or slightly above the county midpoint, partly due to newer construction.
A base ALF monthly rate usually covers housing, three meals, 24-hour supervision, housekeeping, laundry, and activities. What gets billed separately — medication administration above a basic tier, two-person transfers, incontinence supplies, and one-on-one aide time — is where the quoted price and the real bill diverge. Texas Ch. 247 requires facilities to disclose their rate schedule in writing before admission. Always get a full itemized rate sheet and ask specifically what triggers an upgrade to a higher care tier.
Under Texas HHSC rules, a Type A ALF can only serve residents who can self-evacuate in an emergency; a Type B ALF is required for residents who need evacuation assistance. If your loved one uses a wheelchair or has significant mobility limitations, confirm the facility holds a Type B license.
The biggest cost levers in San Antonio are shared-room pricing, choosing a smaller board-and-care home over a large campus, and right-sizing care level to current need. For income-qualifying seniors, the STAR+PLUS Home and Community-Based Services (HCBS) Medicaid waiver covers personal care and support services in an approved ALF setting — it is Texas's equivalent of California's ALW or Florida's SMMC. Eligibility is administered through Texas Medicaid managed care organizations (MCOs) including Molina, UnitedHealth Community Plan, Superior Health Plan, and Centene.
Veterans and surviving spouses should also evaluate VA Aid & Attendance, which can add $1,800–$2,900 a month toward care costs for eligible wartime veterans served by Audie L. Murphy VA Medical Center or the JBSA / Fort Sam Houston community. AACOG (Alamo Area Council of Governments), the Area Agency on Aging for the San Antonio region, can be reached at (210) 362-5200 and helps connect families with local benefits counselors at no cost.
Free, no-pressure call. We work for families, not facilities.