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Plans & Benefits: Texas STAR

Helping you prioritize your health

Your health is important and we’re here to help you stay on top of it. Amerigroup offers STAR health-care benefits for:

  • Pregnant women
  • Kids and some young adults up to age 20
  • Anyone who gets Temporary Assistance for Needy Families (TANF)
  • Children and young adults in the Adoption Assistance and Permanency Care Assistance (AAPCA) programs

Benefits beyond what you expect

At Amerigroup, we’re about more than just doctor’s visits. Along with your regular Medicaid benefits, you’ll get no-cost extras designed with you and your family in mind.

Extra benefits for all
  • Help from a nurse anytime — day or night, with our 24-hour Nurse HelpLine.
  • Real Solutions® Healthy Rewards debit card dollars for achieving health goals or getting certain checkups or screenings, like Texas Health Steps and pregnancy checkups or cholesterol and diabetic screenings.
  • Free cellphone with monthly minutes and texts for those that qualify.
  • Free first aid kit when you complete a personal disaster plan online.
  • Rides to doctor visits when the Texas Health and Human Services Commission (HHSC) Medical Transportation Program (MTP) is not available.
Extras for kids
  • Up to $50 each school year for a Boys & Girls Club membership where available for members ages 6 to 18.
  • One sports or school physical every year for members ages 6 to 18.
  • Allergy-free pillow cover for members age 20 and younger with asthma.
Extras for pregnant members
  • Taking Care of Baby and Me® program for pregnant women and new mothers.
Extras for adults
  • Dental hygiene kit for members age 21 and older.
  • Personal coaching to help quit smoking for members age 18 and over.

You can find specific benefit details, including exclusions and limitations, in the member handbook.

Better, everyday

The benefits and services we offer are made to make a difference in your life. Even better, STAR benefits are no cost to all who are eligible.

Your health benefits

STAR benfits include:

  • Care from a plan primary care provider you choose
  • Prescription drugs
  • Hospital visits
  • Specialist referrals
  • Immunizations (shots)
  • Rides to doctor visits
  • Allergy testing
  • Well-child and well-adult checkups
  • Maternity care
  • Dental care
  • Vision care
  • And more

Visit our Find a Doctor page to find out more about your dental and vision benefits.

Eligibility & Enrollment

Find out if you and your family are eligible for Texas STAR benefits.

You may be eligible for STAR benefits if you have limited income and:

  • You’re pregnant
  • You’re age 20 or younger
  • You get Temporary Assistance for Needy Families (TANF)
  • You’re in the Adoption Assistance or Permanency Care Assistance (AAPCA) programs
  • You must live in our STAR Service area to get STAR benefits from Amerigroup.

To find out if you and your family are eligable for STAR benefits, you can:

  • Call 2-1-1 (TTY 711)
  • Go online and choose What help can you get?

You can apply:

  • Online — Go to the Your Texas Benefits website and choose Apply for new benefits
  • Over the phone — Call 2-1-1 toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time
  • By mail or fax — Print a paper form from the Your Texas Benefits website or call 2-1-1 to have a paper form sent to you
  • In person — Go to a Texas Health and Human Services Commission (HHSC) benefits office near you. You can find one by calling 2-1-1 or visit the Your Texas Benefits website and choose Find an Office

After you’re approved, HHSC will mail you an enrollment packet. You will have to choose a health plan and a primary care provider. Call STAR at 1-800-964-2777 to join Amerigroup.

Pharmacy: Your prescription drug benefits

We work with Express Scripts (ESI) to provide your pharmacy benefits.

You don’t have pharmacy copays.

To learn more about your pharmacy benefits, refer to the member handbook.

Getting your prescription filled is easy!

You can go to any pharmacy in our plan. Use the pharmacy locator tool to find a pharmacy close to you.

  • Give the pharmacist your written prescription or have the doctor call it in
  • Show your Amerigroup ID card or Your Texas Benefits Medicaid card

It’s a good idea to use the same pharmacy for all your prescriptions. This way the pharmacist will know what medicines you’re taking and can tell you about any problems or drug interactions that could occur. If you use more than one pharmacy, tell them about all medicines you take.

Drug Coverage Information

Your doctor chooses drugs from the State Vendor Drug Program (VDP) list of drugs. It includes all medicines covered by Medicaid

View the State Vendor Drug Program list

Prior authorization (preapproval)

Your doctor may need to get preapproval from us for certain drugs before prescriptions are filled.

To ask for an exception, email us at
wrkgp-submitmyexceptionreq@anthem.com.

When there is a generic drug available on the VDP list, it will be covered in place of the brand-name drug. Generic drugs are equal to brand-name drugs as approved by the Food and Drug Administration (FDA).

Searchable Formulary

Search for name brand and generic drugs in the formulary

Drug Interactions and Side Effects

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

Express Scripts Prescription Drug Reimbursement Form

If you paid out-of-pocket for a prescription drug, you can ask us to pay you back. Please use the form below to request reimbursement.

Manage your prescriptions online

ESI online registration instructions:

Pharmacy: Frequently asked questions

What pharmacies are in the Amerigroup plan?

There are many chain and local pharmacies in our plan to choose from. You can find one by:

How do I transfer my prescriptions to a pharmacy in the plan?

If you need to transfer prescriptions:

  • Call a pharmacy in our plan and tell the pharmacist you want to transfer a prescription.
  • Bring your prescription container to the new pharmacy and they will handle the rest.

How does my provider request preapproval?

Your doctor can request preapproval by:

  • Faxing a completed prior authorization (preapproval) form to
    1-800-601-4829.
  • Calling the Amerigroup Pharmacy department at 1-855-215-4496.

What if a copay is required and I’m unable to pay it?

You don’t have pharmacy copays.

How do I get my medicine if I’m traveling?

We have pharmacies in our plan in all 50 states. Call your doctor for a new prescription to take with you on vacation.

What happens if my child’s medicines are lost or stolen?

If your medicines are lost or stolen, call the doctor and ask him or her to call your pharmacy to authorize an early refill. The pharmacy may have to contact our Prior Authorization Desk for approval. We will review lost or stolen medicines on a case-by-case basis.

What if I paid out of pocket for a medicine and want to be reimbursed?

If you had to pay for a medicine, you may submit a request for reimbursement form. You’ll need to mail the completed Express Scripts Prescription Drug Reimbursement Form; Spanish form along with any receipts to:

Amerigroup
Pharmacy Department
PO Box 62509
Virginia Beach, VA 23466-2509

Texas Health Steps

Keep your child healthy with Texas Health Steps

Texas Health Steps is health care for people up to age 20 who have Medicaid. Starting at birth, your child can get medical checkups at no cost. Dental checkups are also no cost starting at 6 months of age.

Call Texas Health Steps toll-free at 1-877-847-8377 (1-877-THSTEPS) or go to Texas Health Steps to learn more

Are you a Farm Worker?

Learn more about health-care benefits for your kids.

FAQs

Find answers to your questions below.

Who is Amerigroup?

Amerigroup is a health plan in Texas. We offer STAR health-care benefits to those who qualify, along with other program benefits.

What is STAR?

STAR is a Texas Medicaid managed care program. STAR provides no-cost health benefits to people who meet income guidelines including:

  • Pregnant women
  • Kids and some young adults up to age 20
  • Anyone who gets Temporary Assistance for Needy Families (TANF)

The Texas Health and Human Services Commission (HHSC) decides who is able to get STAR benefits.

I get Medicaid benefits through the AAPCA program, when will I move into STAR?

A: Starting September 1, 2017, people in AAPCA will move into STAR if they don’t:

  • Get Supplemental Security Income (SSI)
  • Get Medicare 1915(c) waiver services
  • Have a disability as determined by the U.S. Social Security Administration or the State of Texas
  • Don’t live in a nursing facility
  • Don’t live in an intermediate care facility for individuals with intellectual or developmental disabilities or related conditions (ICF/IID)

Can I keep seeing my current doctors after I join a health plan as an AAPCA member?

A: You can keep seeing your current doctors if they’re in our health plan. We can approve for you to keep seeing your current doctors for 90 days if they’re not in our health plan. After 90 days, you’ll need to see a doctor in our plan, and we’ll help you find one.

How do I apply for STAR?

It’s easy. You can apply for STAR benefits:

  • Over the phone
    • Call 2-1-1 toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time
  • Pick a language Online at YourTexasBenefits.com
    • Choose option 2 and follow the prompts
  • By mail or fax
    • Call 2-1-1 to have a paper application form sent to you or print a paper copy of the form at YourTexasBenefits.com
    • Mail your form to:
      HHSC
      PO Box 149024
      Austin, TX 78714-9968
    • Fax your form to: 1-877-447-2839
  • In person at an HHSC benefits office
    • Call 2-1-1, pick a language, and then select option 2 to find an office
    • Go to YourTexasBenefits.com and choose Find an Office

You can set up an account at YourTexasBenefits.com and download the Your Texas Benefits app to check your application status and much more. If you qualify, HHSC will mail you an enrollment packet. You will have to choose a health plan and a primary care provider. Call the STAR Help Line at 1-800-964-2777 to choose Amerigroup.

What does it cost?

There is no cost to those who qualify for Medicaid benefits from Amerigroup

I just lost my benefits. How do I re-enroll?

In order to keep your Medicaid benefits, you have to recertify every 12 months. You should get a letter from HHSC when it’s time to renew. Follow the instructions in your renewal letter on time, or renew online at YourTexasBenefits.com.

To find out how to recertify, call 2-1-1. Make sure HHSC has your correct contact information.

What benefits do I get with Amerigroup?

We offer all the regular STAR benefits, plus extras designed to make a difference in your day-to-day life. Amerigroup members get things like extra transportation benefits, debit cards for getting some checkups and screenings, programs for pregnant women and new moms, Boys & Girls Club memberships and more.

Our STAR Plans and benefits page will tell you more about the benefits you can get with us.

Do I have to choose a health plan?

Yes. When you or your child gets Medicaid, you must choose a health plan in your area or HHSC will pick one for you.

If you want to change plans, call the STAR Help Line at
1-800-964-2777.

Can I keep the same doctor?

Yes — as long as he or she is in our plan. You can check to see if your doctor is in our plan by going to the Find a Doctor page.

Can I see a doctor outside of the Amerigroup plan?

Sometimes you may need to see a doctor who isn’t part of our plan. But you will need to get preapproval first. Call Member Services before you see a doctor who isn’t in our plan.

In an emergency, you can see any doctor or go to any hospital.

How do I switch my primary care provider?

Choose a new primary care provider using the Find a Doctor search tool. To make a change:

  • Call Member Services at 1-800-600-4441 (TTY 711), or
  • Log in to your account.

The change will start right away, and you’ll get a new ID card in the mail within 10 business days.

Will I lose my benefits if I switch my primary care provider?

No — you won’t lose any benefits as long as he or she is in our plan.

Can my children and I have different doctors?

Yes.

Are prescription drugs covered?

Yes, we use the State Vendor Drug Program list list of drugs for your doctor to choose from. Some prescriptions will need preapproval.

You can go to any pharmacy in our plan to have your prescriptions filled.

To find out more, call Member Services at 1-800-600-4441 (TTY 711).

What is preapproval?

Some treatment, care, or services may need our approval before your or your child’s doctor can provide them. This is called preapproval. Your or your child’s doctor will work directly with us to get the approval. The following require preapproval:

  • Most surgeries, including some outpatient surgeries
  • All elective and nonurgent inpatient services and admissions
  • Chiropractic services
  • Most behavioral health and substance abuse services (except routine outpatient and emergency services)
  • Certain prescriptions
  • Certain durable medical equipment, including prosthetics and orthotics
  • Certain gastroenterology procedures
  • Digital hearing aids
  • Home health services
  • Hospice services
  • Rehabilitation therapy (physical, occupational, respiratory, and speech therapies)
  • Sleep studies
  • Out-of-area or out-of-network care except in an emergency
  • Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans)
  • Certain pain management testing and procedures

This list is subject to change without notice and isn’t a complete list of covered plan benefits. Learn more about your benefits by:

  • Reading your member handbook
  • Calling Member Services with questions about specific services

How do I replace my Amerigroup ID card if it is lost or stolen?

If your ID card is lost or stolen, call us right away at 1-800-600-4441 (TTY 711). We’ll send you a new one. You may also print your ID card from our website. You’ll need to register and log in to the website to access your ID card information.

How can I get a new ID card, handbook, or provider directory?

Log in or call Member Services at 1-800-600-4441 (TTY 711) to ask for one.

Who do I call if I have concerns about my health-care benefits?

Call Member Services at 1-800-600-4441 (TTY 711).

If you have health-related questions, call that same number for help from a nurse 24 hours a day, 7 days a week with our 24-hour Nurse HelpLine.

Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc.