- 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.
- Outpatient services, including:
- 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
- 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:
- 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.