Quick Answer
Long-term care insurance is private coverage you bought; it pays once the benefit trigger and elimination period are met, with no income or asset test, and you can use any licensed agency the policy accepts. Texas Medicaid's STAR+PLUS program is for people with limited income and assets: in 2026, income up to $2,982 a month and countable assets of $2,000 or less for a single person. It uses Medicaid-contracted providers, and there may be an interest list.
In This Guide
Key Takeaways
- →LTCI pays based on the policy, with no income or asset test. Medicaid requires low income and assets.
- →2026 STAR+PLUS limits: income up to $2,982/month and countable assets of $2,000 for a single person.
- →LTCI lets you choose any licensed agency the policy accepts. Medicaid uses providers contracted with your health plan.
- →People not already on Medicaid may be placed on an interest list for STAR+PLUS home care services.
- →BlueBonnet accepts private pay and long-term care insurance. We don't accept Medicaid.
When families start figuring out how to pay for care at home, two names come up most: long-term care insurance and Medicaid. They work very differently, and most families qualify for only one of them. This guide lays out the differences so you can see which applies to you.
The Basic Difference
- Long-term care insurance (LTCI) is a private policy your family paid premiums on. It pays based on the policy's terms, whatever your income or savings.
- Medicaid STAR+PLUS is Texas's public program for older adults and people with disabilities who have limited income and assets. Its Home and Community Based Services (HCBS) program pays for help at home for people who would otherwise qualify for a nursing facility.
Side-by-Side Comparison
| Long-term care insurance | Medicaid STAR+PLUS HCBS | |
|---|---|---|
| Who qualifies | Anyone with an active policy who meets its benefit trigger | Texans with limited income and assets who need nursing-facility level care |
| Income and asset test | None | 2026: income up to $2,982/month; countable assets $2,000 (single) or $3,000 (couple) |
| How long it takes | Several weeks to approve, plus the elimination period | Applications take time; people not already on Medicaid may wait on an interest list |
| What it pays | A daily or monthly dollar amount set by the policy | A number of authorized service hours set in a care plan |
| Choice of provider | Any licensed agency the policy accepts | Providers contracted with your Medicaid health plan, or self-directed care |
| How long it lasts | Until the policy's benefit period or pool runs out | As long as eligibility continues |
Figures are 2026 Texas limits. Medicaid rules are complex, so confirm your situation with Texas Health and Human Services or an elder law attorney.
Which Applies to Your Family?
- Has a policy, doesn't meet Medicaid limits: use the long-term care insurance. This is the most common situation for middle-income families. See how to use LTCI for home care.
- No policy, meets Medicaid limits: apply for STAR+PLUS through Your Texas Benefits or 211, and ask about the interest list. Our STAR+PLUS guide explains the steps.
- No policy, doesn't meet Medicaid limits: most families pay privately, sometimes with help from VA benefits or HSA or FSA funds. An elder law attorney can help with long-term planning.
- Has a policy and may qualify for Medicaid later: use the policy first, and talk with an elder law attorney about the transition.
Can You Use Both?
Rarely at the same time. Most people with long-term care insurance have too much income or savings to qualify for Medicaid. A more common sequence is using the policy for several years until its benefits run out, by which point savings may also have been spent on care. Insurance payments can also affect Medicaid eligibility, so get advice from an elder law attorney before relying on both.
About Spending Down to Qualify
Some families assume Medicaid will simply take over once private funds run low. In practice, a single person must reduce countable assets to $2,000, which can take a long time. Some assets, such as the home in many situations, one vehicle and personal belongings, generally don't count. There are also rules about gifts and transfers made before applying, and protections for a spouse who stays at home.
Because mistakes here can be costly, this is a conversation for an elder law attorney, not a do-it-yourself project.
Where BlueBonnet Fits
BlueBonnet Home Health accepts private pay and long-term care insurance. We don't accept Medicaid. For families with a policy, we confirm benefits with the carrier before care starts, bill the carrier directly, and review caregiver logs weekly so claims keep paying. Read more on our long-term care insurance page.
If your family is applying for Medicaid and needs care in the meantime, private-pay care can fill the gap while you wait.
Frequently Asked Questions
What is the income limit for Texas Medicaid STAR+PLUS home care in 2026?
For STAR+PLUS Home and Community Based Services, the 2026 income limit is $2,982 a month for a single person, which is 300% of the federal SSI benefit. Countable assets must be $2,000 or less for a single person, or $3,000 for a couple.
Does long-term care insurance have an income limit?
No. Long-term care insurance pays according to the policy once the benefit trigger and elimination period are met, whatever the policyholder's income or assets.
Can I choose my own home care agency with Medicaid?
Medicaid home care in Texas is provided through agencies contracted with your Medicaid health plan, or through self-directed care. With long-term care insurance, you can generally choose any licensed agency the policy accepts.
Can you have long-term care insurance and Medicaid at the same time?
It's uncommon, because most policyholders have too much income or savings for Medicaid, and insurance payments can affect eligibility. Families more often use a policy first. An elder law attorney can advise on specific situations.
What payment does BlueBonnet Home Health accept?
BlueBonnet accepts private pay and long-term care insurance, and does not accept Medicaid. Families waiting on Medicaid sometimes use private-pay care in the meantime.
Related Reading
If your family has a long-term care insurance policy, we'll check your benefits with the carrier at no cost. Call (346) 689-2339.
Have a Long-Term Care Policy?
We'll confirm your benefits with your carrier before care starts and bill them directly.
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