How the Medicare hospice benefit works in San Antonio, Texas — eligibility, the four levels of care, what it pays for in an assisted living facility, and how to verify a Bexar County hospice agency's license.
By San Antonio Senior Advisor Care Team · September 22, 2026
The Medicare hospice benefit in San Antonio, Texas is not a facility, a building, or a place your parent moves into — it is a Part A benefit that travels with the person and is delivered wherever they already live. That is the single most useful thing a Bexar County family can understand on day one, because it means hospice can come to a house in Southtown, an apartment in Stone Oak, a Type B assisted living facility in Alamo Heights, or a licensed nursing facility on the far West Side. To elect the benefit, three conditions must be met. First, the person must be enrolled in Medicare Part A. Second, two physicians — the hospice medical director and the person's own attending physician, if they have one — must certify that the illness is terminal with a prognosis of six months or less if the disease runs its normal course. Third, the person (or their agent under a Texas statutory medical power of attorney) must sign an election statement choosing comfort-focused care for the terminal diagnosis instead of curative treatment for that same diagnosis.
The six-month prognosis language causes more confusion in San Antonio families than anything else in this benefit, so it is worth being precise. It is a clinical estimate, not a deadline and not a contract. People routinely live longer than six months on hospice, and the benefit does not expire when they do. Medicare structures hospice into benefit periods: two initial periods of 90 days each, followed by an unlimited number of 60-day periods. Before each recertification at or after the third benefit period, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the patient and document continued eligibility. Families at Methodist Hospital, Baptist Medical Center, or UT Health University Hospital who hear a discharge planner say "hospice" often assume it means days. It does not. It means the clinical team believes the trajectory is now about comfort, function, and symptom control rather than reversal — and Texas families frequently use that benefit for many months.
Medicare hospice eligibility opens a package, not a single service. There are four defined levels of care, and any hospice agency serving Bexar, Comal, Guadalupe, or Kendall County must be able to provide all four. Routine home care is the default and by far the most common — scheduled nurse visits, a hospice aide for bathing and personal care, social work, chaplaincy, volunteer support, and bereavement services for the family for up to 13 months after death. Continuous home care is short-term crisis nursing, delivered predominantly by a nurse in the home during a period of acute symptom escalation, to prevent an unnecessary emergency-room trip. Inpatient respite care moves the patient into a Medicare-contracted facility for up to five consecutive days specifically so the family caregiver can rest. General inpatient care is short-term admission for pain or symptom management that cannot be controlled in the home setting.
On the payment side, the hospice benefit covers the interdisciplinary team, medications related to the terminal diagnosis and its symptoms, durable medical equipment such as a hospital bed, oxygen concentrator, wheelchair, or bedside commode, and medical supplies — all related to the terminal illness. Cost sharing is deliberately minimal: Medicare allows a copayment of up to $5 per prescription for outpatient symptom-relief drugs, and 5% of the Medicare-approved amount for inpatient respite care. Many agencies waive even those. What the benefit does not pay is the single most important exclusion for San Antonio families, and it is covered in the next section. Care unrelated to the terminal diagnosis also continues to be billed normally under the person's other Medicare coverage — hospice for end-stage heart failure does not stop Medicare from covering treatment for an unrelated broken wrist.
Here is the trap. If your mother lives in a Type B assisted living facility in Bexar County and elects hospice, Medicare pays the hospice agency for the clinical care — nurses, aides, medications for the terminal condition, equipment, social work, chaplain. Medicare does not pay her monthly rent at that assisted living facility. Room and board remains a private-pay obligation, exactly as it was the day before hospice started. Families hear "Medicare covers hospice 100%" and reasonably conclude the assisted living bill goes away. It does not, and discovering that in month two is a preventable financial shock. The same principle applies in a nursing facility: the hospice benefit covers hospice services, but the nursing facility's daily room-and-board charge is separate.
There is one significant exception, and it matters for dual-eligible San Antonians. If the person is enrolled in both Medicare and Texas Medicaid and resides in a Medicaid-certified nursing facility, Texas Medicaid can pay the room-and-board component while Medicare pays the hospice care, with the room-and-board payment routed through the hospice agency. That coordination is a Texas Medicaid hospice function and requires the person to be Medicaid-eligible for nursing facility services — it is not automatic and it does not apply to assisted living. Families in this situation should ask the hospice agency's social worker and the facility's business office to confirm the arrangement in writing before the first month closes. If your parent is on a STAR+PLUS managed care plan through Molina, Superior (Centene), UnitedHealthcare, or Amerigroup, loop the plan's service coordinator in as well, because electing hospice changes how some services are authorized.
In Texas, hospice agencies are licensed by Texas Health and Human Services (HHSC) as home and community support services agencies carrying a hospice license category, under Texas Health and Safety Code Chapter 142. That license is a public record, and you can and should check it before signing an election statement. HHSC publishes provider licensing and regulatory history through its public disclosure search at apps.hhs.texas.gov/HSPubDisclosure. Confirm the agency holds a current hospice license, that the address on the license matches the office you are dealing with, and review any enforcement history. Separately, Medicare publishes hospice quality and family-survey data on Care Compare at medicare.gov/care-compare, which lets you compare San Antonio agencies on measures like how often patients got timely visits in the last days of life and how families rated communication.
Ask four concrete questions before you choose. Who comes out after hours and on weekends, and is that person an employee of this agency or an answering service? How quickly can you provide continuous home care if symptoms escalate at 2 a.m.? Where do you provide general inpatient and respite care — which specific facility, and is it in San Antonio or somewhere the family would have to drive to? And, in a market where roughly two-thirds of residents are Hispanic, is there Spanish-speaking clinical staff, not just a translation line? ¿Hay personal de enfermería que hable español? That question is not a courtesy — for a patient whose English recedes as illness progresses, a Spanish-speaking nurse is a clinical safety issue, not a preference. Get the answers from the agency, in writing where possible, and compare at least two agencies.
San Antonio is a military city, and veterans have a second track worth knowing. The South Texas Veterans Health Care System, anchored by the Audie L. Murphy VA Medical Center, provides hospice and palliative care to enrolled veterans, and the VA can also contract with community hospice agencies. A veteran enrolled in VA health care who is also on Medicare has options — including VA-paid inpatient hospice, community hospice under the Medicare benefit, or a combination — and the right answer depends on service connection, enrollment priority group, and where the veteran wants to be. Ask for the palliative care team at Audie Murphy, and ask the Texas Veterans Commission (tvc.texas.gov) about any benefits that stack, including whether an existing VA Aid and Attendance pension continues alongside hospice. It generally does, because Aid and Attendance is a pension benefit, not a medical one.
If the conversation is starting because of a hospital discharge, the discharge planner at Methodist, Baptist, Christus Santa Rosa, UT Health University Hospital, or BAMC is required to give you a list of agencies serving the area, and you are entitled to choose — you are not obligated to take the first name offered. Take the list, run the licenses through the HHSC search, check Care Compare, and call two. For free, unbiased local help, the Alamo Area Council of Governments (AACOG) operates the Area Agency on Aging for the region at aacog.com or (210) 362-5200, with benefits counseling and caregiver support at no cost. If a loved one is in a licensed facility and you have a concern about their care on hospice, the Texas Long-Term Care Ombudsman program is a separate, free advocate. And keep the Texas paperwork straight: a medical power of attorney, an out-of-hospital DNR if that reflects the person's wishes, and a directive to physicians are Texas-specific documents that should be in place and in the chart before a crisis, not during one.
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