McAllen Senior AdvisorDoes Medicare cover a winter resident who gets sick in McAllen?
Original Medicare works at any Medicare provider in the country, so a winter resident with Original Medicare is covered at Valley hospitals, nursing homes and home health agencies just as at home; Medicare Advantage plans are different and may cover only emergencies and urgent care outside their home network.
Before the season, call the plan and ask how it covers care in Hidalgo County, including a rehab stay after a hospitalization. Some plans have travel or visitor programs; many do not. A seasonal resident from Canada is not covered by Medicare and depends on their provincial plan and travel insurance.
Can a winter resident use Texas Medicaid or STAR+PLUS?
Generally not while they are a resident of another state: Medicaid is run by each state for its own residents, so a seasonal visitor's home-state Medicaid usually will not pay a Texas provider for long-term care, and Texas Medicaid requires Texas residency.
A seasonal resident who decides to stay permanently in the Valley can establish Texas residency and apply here, which takes time. Families should plan for private payment, or a return home, in the meantime.
What if a winter resident cannot travel home after a hospital stay?
They may need a short rehab stay in a Hidalgo County nursing home, paid by Medicare if they had a qualifying three-day inpatient stay, followed by a plan to return home with family help or by medical transport when they are stable.
Ask the hospital case manager to talk with the family back home early, and to send records to the parent's regular doctor. Rehab homes in the Valley are used to coordinating with families in other states.
Should a seasonal resident consider staying in the Valley for care?
Some do, especially if they have spent many winters in the Valley and have friends there, but the decision should weigh where adult children live, which state's benefits the person can use, and the limited supply of assisted living in Hidalgo County.
Hidalgo County has 16 licensed assisted living facilities (378 places) against 23 nursing homes (2,818 beds), 130 adult day centers and 434 home health and attendant agencies. For a person who needs residential care for the long term, being near family who can visit usually matters more than climate.
What should winter residents prepare before the season?
Bring a current medication list, copies of insurance cards and advance directives, the name of a contact back home, and the plan's rules for out-of-area care, and register with a local pharmacy and urgent care before you need them.
Many RV and manufactured home parks keep emergency contact lists; give yours to the park office. If health is declining, talk with family before the trip about the point at which care should be arranged at home instead.
Sources: Texas Health and Safety Code ch. 247 and 242; 26 TAC chapters 553, 554, 558 and 559; HHSC directories, TULIP and handbooks; CMS; CareScout; VA rate tables, as cited above. See our editorial standards.
