Health Care Benefits

  • 72-hour supplies of emergency prescriptions
  • Ambulance services
  • Audiology services (hearing tests) including hearing aids for adults (audiology services and hearing aids for children under the age of 21 are a non-capitated service)
  • Behavioral Health
    • Inpatient mental health services for adults and children
    • Outpatient mental health services for adults and children
    • Outpatient chemical dependency services for children (under age of 21)
    • Detoxification services
    • Psychiatry services
    • Counseling service for adults (21 years of age and over)
  • Substance use disorder treatment services, including:
    • Outpatient services, including:
      • Assessment
      • Detoxification services
      • Counseling treatment
      • Medication assisted therapy
    • Residential services, including:
      • Detoxification services
      • Substance use disorder treatment
    • Mental Health Rehabilitative Services: Services that reduce a Member’s disability resulting from severe mental illness, serious emotional, behavioral, or mental disorders
    • Targeted Case Management: Services that assist Members with getting access to needed medical, social, educational, and other services and supports.
  • Birthing services provided by a physician or Advanced Practice Nurse in a licensed birthing center
  • Birthing services provided by a licensed birthing center
  • Cancer screening, diagnostic and treatment services
  • Chiropractic services
  • Dialysis
  • Disease management programs
  • Drugs and biologicals provided in an inpatient setting
  • Durable medical equipment and supplies
  • Early childhood intervention services
  • Emergency services
  • Family planning services
  • Health education related to obesity
  • Home health care services, including home telemonitoring
  • Hospital services, inpatient and outpatient
  • Laboratory services
  • Mastectomy, breast reconstruction, and related follow-up procedures, including:
    • Outpatient services provided at an outpatient hospital and ambulatory health care center as clinically appropriate; and physician and professional services offered in an office, inpatient, or outpatient setting for:
      • All stages of reconstruction on the breast(s) on which medically necessary mastectomy procedure(s) have been performed
      • Surgery and reconstruction on the other breast to produce symmetrical appearance
      • Treatment of physical complications from the mastectomy and treatment of lymphedemas
      • Prophylactic mastectomy to prevent the development of breast cancer
    • External breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed
  • Medical checkups and Comprehensive Care Program (CCP) Services for children (under age 21) through the Texas Health Steps Program
  • OB/GYN
  • Optometry, glasses, and contact lenses, if medically necessary
  • Oral evaluation and fluoride varnish in the Medical Home along with Texas Health Steps medical checkup for children 6 months through 35 months of age
  • Outpatient drug programs
  • Outpatient drugs and biologicals; including pharmacy-dispensed and provider-administered outpatient drugs and biologicals
  • Prenatal Care
  • Podiatry
  • Primary care provider services
  • Preventive services including an annual adult wellcheck for patients 21 years of age and over
  • Radiology, imaging, and X-rays
  • Service Coordination
  • Specialty physician services
  • Therapies: physical, occupational, and speech
  • Transplantation of organs and tissues
  • Vision Care

If you have Medicare coverage and STAR+PLUS, your Medicare coverage will be your primary coverage. This means that your Medicare coverage is always the first insurance to be used. STAR+PLUS will not change your Medicare coverage.

If you can receive Medicare and Medicaid, you are Dual-Eligible. If you have questions about your Medicare benefits and coverage, please visit www.medicare.gov.