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Plans & Benefits: Texas STAR+PLUS

Amerigroup* is a health plan in the Texas STAR+PLUS program. This program serves mainly elderly and disabled persons who are SSI recipients. Amerigroup helps you manage the health-care and long-term services and supports benefits you can get from your Medicaid coverage. We also help coordinate with Medicare benefits if you have them.

You’ll get the STAR+PLUS benefits you need to help meet all of your health-care needs. With Amerigroup, you get benefits such as:

  • Medical benefits like hospitalization, doctor visits, and prescriptions
  • Behavioral health services
  • Long-term services and supports – home/community-based care or nursing facility services if you live in a nursing facility
  • Service coordination to help make sure all of your health-care needs are met
  • Member Services and service coordination toll-free numbers to help you with your benefits
  • 24-hour Nurse HelpLine to answer your health questions

For value-added benefits from Amerigroup in addition to regular Medicaid and Medicare benefits, see the Benefits Overview section below.

For detail information on all benefits, please refer to the Member Handbooks.

If you also have Medicare

If you have both Medicaid and Medicare, Medicare will provide your health-care benefits such as:

  • Hospitalization
  • Behavioral health
  • Doctor visits
  • Prescriptions

Amerigroup will provide your STAR+PLUS long-term services and supports benefits when you need them.

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Benefits Overview

Here is a summary of the benefits you get as an Amerigroup member.

Benefits Overview - Dual

Benefits Overview - Non-Dual

Nursing Facility Benefits Overview

Do you need a referral or prior authorization?

Sometimes your primary care provider will need you to see a specialist or another provider for care or services he or she can’t provide. This is called a referral. Your doctor may also need us to approve certain services before you get them. This is called prior authorization. You can get OB/GYN, family planning, and behavioral health services without a referral from your doctor. This is called self-referral. To get these services, make an appointment with a doctor in our network. You can find a list of doctors using the Find a Doctor search tool.

To learn more about referrals and prior authorizations, click on the links below.

Referrals and Prior Authorizations

For STAR+PLUS dual members:

What does it cost?

Medicaid benefits through Amerigroup are provided at no cost to those who qualify. You do not have to pay any premiums, enrollment fees, deductibles, copayments, or cost sharing for the Medicaid part of your coverage. For information on the costs of your Medicare benefits, you can contact your Medicare plan or refer to the plan information they sent you.

What if Amerigroup doesn’t have a provider for one of my covered benefits?

If a covered benefit is not available to you through a network provider, Amerigroup will arrange services with an out-of-network provider and will reimburse the out-of-network provider according to state rules. You must contact Member Services at 1-800-600-4441 to arrange out-of-network services except in case of emergency. If you have an emergency, you should call 911 or go to the nearest hospital emergency room right away.

For STAR+PLUS non-dual members:

What does it cost?

Medicaid health insurance benefits through Amerigroup are provided at no cost to those who qualify. There are no premiums, enrollment fees, deductibles, copayments, or cost sharing for covered benefits.

Do I need a referral to see a specialist?

You will go to your primary care provider for most of your health care, or your primary care provider will send you to a specialist in the Amerigroup network. For more information, please check your member handbook or call Member Services at 1-800-600-4441 (TTY 711).

For STAR+PLUS Nursing Facility members:

What does it cost?

As an Amerigroup member, you will have to provide your applied income to the nursing facility as your share of the cost. Applied income means the part of your personal income that you must give to the nursing facility each billing period. Any time Medicaid bills the nursing facility, you must give your applied income to the facility. Your cost is determined by the total amount of your monthly income divided by the number of days you live in the facility each month. You are allowed to keep $60 for yourself for personal needs.

There are no costs for your benefits except the monthly applied income amount you pay to the nursing facility. You will not have to pay any deductibles or copays.

Do I need a referral to see a specialist?

You will see your primary care provider for most of your health-care needs, or your primary care provider will send you to a specialist in the Amerigroup network. For more information, please check the member handbook or call Member Services at 1-800-600-4441 (TTY 711). If you have Medicare, you will need to follow your Medicare plan’s rules about referrals for Medicare-covered services.

Service Coordination

Service coordination helps make sure all your care and services are working together. By communicating regularly with you and your providers, service coordinators help to keep everyone involved in your care informed of your needs and goals. Your service coordinator will work with you and your primary care provider to help you get needed services. He or she will also:

  • Visit you at your home to learn about your health needs and goals and help create your service plan.
  • Help you make appointments to see your providers and help you get covered services when you need them.
  • Help you get authorizations for needed services.
  • Coordinate all of the services you get from us and other providers and community organizations.
  • Encourage you to take part in your care, so you can stay healthy and live independently.

You can have a service coordinator if you ask for one. We may also assign one after we look at your health and support needs. If you think you need a service coordinator or if you’d like to speak with one, call Member Services at 1-800-600-4441 (TTY 711).

Eligibility & Enrollment

Get the benefits you need – doctor visits, hospitalization, health screenings, prescription coverage, and more. Find out if you’re eligible and how to choose Amerigroup.

Eligibility & Enrollment

Pharmacy & Prescription Drugs

Amerigroup works with Express Scripts to provide your pharmacy benefit. We cover a wide range of prescriptions and many over-the-counter medicines.


STAR+PLUS members do not have pharmacy copays.

Search for name brand and generic drugs
that are on your formulary:

Searchable Formulary

Pharmacy & Prescription Drugs

Prior Authorization

You can email and ask us for an exception at wrkgp-submitmyexceptionreq@anthem.com.

Drug Interactions and Side Effects

Learn more about drug interactions or side effects on the ESI Drug Information website.

Express Scripts Prescription Drug Reimbursement Form

ESI Online Registration Instructions

FAQs

Find answers to your questions below.

FAQs - Medicaid/Medicare (Dual) Members

FAQs - Medicaid (Non-Dual) Members

FAQs - Nursing Facility Members

*In Texas, Amerigroup members in the Medicaid Rural Service Area are served by Amerigroup Insurance Company; all other Amerigroup members are served by Amerigroup Texas, Inc.