STAR+PLUS

There are no copays for covered services.

• Primary care provider (PCP) visits
• Prescription drugs
• Specialist visits
• Hospital care
• Preventive care
• Urgent care
• Emergency care
• Lab and X-ray services
• Behavioral health care (mental health and substance abuse services)

If you have both Medicare and Medicaid, Medicare will provide your acute care benefits.

See your member handbook for a full list of benefits in your plan.

You may need help with everyday tasks like dressing yourself, preparing meals, light housekeeping, or personal care. Our service coordinators can help you get the long-term services and supports you need to live in your own home or community. The kind of long‐term services and supports benefits you can get is based on your category of Medicaid eligibility. Your member handbook can tell you about the available benefits.

In order to get long-term services and supports, you must first meet with your service coordinator to talk about the kinds of help you may need. To speak with a service coordinator, call Member Services at 1-800-600-4441 (TTY 711).

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).

Many people use long term services and supports for help with daily activities.

Consumer directed services means that you, or someone you choose, coordinate (or direct) your health-care services, not the insurance company.

Learn more about consumer directed services.

If you live in a nursing facility, most of your care will come from the nursing facility. Services include:

• Daily care services, like:
  • Room and board
  • Medical supplies and equipment
  • Personal needs items
  • Social services
  • Over-the-counter drugs
• Nursing facility add-on services, which include:
  • Emergency dental services
  • Physician ordered-rehabilitative services
  • Augmentative communication devices
  • Customized power wheelchairs

Your costs for STAR+PLUS
You pay nothing except the monthly applied income amount you pay to the nursing facility.

If you have Medicare, we pay your percentage of the costs for a Medicare-covered stay for nursing facility daily care services. Your Medicare plan or Texas Medicaid pays your percentage of the costs for nursing facility add-on services.

• If you’re a Home and Community Based Services (HCBS) STAR+PLUS Waiver (SPW) member, talk to your service coordinator about dental services.
• If you have Medicare, contact your plan to learn about dental services.
• If you only have Medicaid and aren’t a SPW member, we only cover emergency dental services.

Amerigroup offers vision care through Superior Vision of Texas. To find an eye doctor and learn about covered services, call Superior Vision of Texas at 1-800-428-8789 or go to the Superior Vision website.

If you have both Medicare and Medicaid, contact your Medicare plan for your vision benefits.

You can get no-cost rides to your health-care services. Amerigroup will provide rides to the doctor, dentist, hospital, pharmacy, and any other place you receive Medicaid services. Call us at least two working days before you need a ride. If you need to travel out of town, or out of your service area, call us at least five working days before you need a ride.

Amerigroup will use Access2Care to arrange all travel. Call 844-867-2837 (TTY 711) to schedule a ride.

Visit the Transportation page under the Benefits tab for more details. 

Transportation benefits are limited for nursing facility members.

We are here to help you with more than just doctor visits. Starting September 1, 2020, you can receive these free extra benefits designed to help support you:

• Earn Healthy Rewards dollars by doing healthy activities like completing certain checkups or treatments. Then, use your dollars to pick gift cards to use at your favorite retailers. 
• Online mental health — access to a secure website and mobile app to help improve mental and emotional health, anytime you need it
• Rides for:
  • Family members to go with you to medical services
  • Pregnancy, birthing, or newborn classes for pregnant members
  • Trips to WIC offices
  • Member Advisory Group meetings
• Cellphone or smartphone with monthly minutes, data, and texts
• Pest control services once every three months
• First aid kit and a personal disaster plan
• Plastic/polycarbonate eyeglass lenses every 36 months
• Help from a nurse, day or night, to answer your health questions with 24-hour Nurse HelpLine
• Respite care hours in order for family members and caregivers to take a break
• Up to 20 home-delivered meals after being discharged from a hospital or nursing facility
• Personal exercise kit
• Dental hygiene kit for members
•  Taking Care of Baby and Me® program for pregnant women and new moms
• We will cover the cost of your General Education Diploma (GED) test for members age 18 and older.
• Access to special programs:
  • Weight management virtual program
  • Nicotine recovery support program
  • Pregnancy and early parenting program
  • Social services resource directory

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

• Medicaid (Non-Dual) Member Handbook – English
• Medicaid (Non-Dual) Member Handbook – Spanish
• Medicaid/Medicare (Dual) Member Handbook – English
• Medicaid/Medicare (Dual) Member Handbook – Spanish
• STAR+PLUS Nursing Facility Member Handbook – English
• STAR+PLUS Nursing Facility Member Handbook – Spanish

Sign up for our Healthy Rewards program and earn rewards for completing healthy activities, like getting certain checkups or screenings.

Healthy Rewards are available beginning September 1st, 2020.

• $20 each year for completing Texas Health Steps checkups, for members ages 18 to 20
• $20 each year getting a flu (influenza) vaccination (gift card allowance for over-the-counter medicines)
• $50 for getting a cervical cytology (Pap smear), for members ages 21 to 64, once every three years
• $50 for getting a cervical cytology (Pap smear) with human papillomavirus (HPV) cotesting, for members ages 30 to 64, once every three years
• $20 for having a follow-up outpatient visit with a mental health provider within seven days of discharge from the hospital for a mental health stay, up to four times per year

For members with diabetes

• $20 every 6 months for getting a blood sugar test (HbA1c)
• $20 every 6 months for getting a blood sugar test (HbA1c) with a result less than eight
• $20 each year for members through age 64 with schizophrenia or bipolar disorder on antipsychotic medicine and who have a diabetes screening (test). Members already diagnosed with diabetes are excluded from this reward.

For pregnant members

• $25 for getting a prenatal checkup in the first trimester of pregnancy or within 42 days of joining the health plan
• $50 for getting a postpartum checkup within 7 to 84 days after giving birth

Sign into your secure account to access Healthy Rewards.

You can find specific benefit details, including exclusions and limitations, in the member handbook. Members with Medicare are not eligible for Healthy Rewards.

STAR+PLUS Medicaid/Medicare (Dual) members

If you have both Medicare and Medicaid, contact your Medicare Part D plan to learn more about pharmacy benefits.

STAR+PLUS Medicaid (Non-Dual) members

Your benefits include a wide range of prescription drugs. We work with CarelonRx to provide these pharmacy benefits.

You do not have pharmacy copays.

Visit the Pharmacy page to find a pharmacy near you and check if your medicine is covered.

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

You will need preapproval for:

• 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)
• Genetic testing
• 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
• Long-term services and supports

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

Referrals

You may need to see a specialist or another provider for care or services that your primary care provider can’t give you. You don’t need a referral from your primary care provider to get care from other doctors in our plan. This includes behavioral health services, OB/GYN care, and family planning. It’s a good idea to talk to your primary care provider first about other types of care you may need. He or she can tell you about other doctors in our plan and help you coordinate the care you receive.

You can learn more about the preapprovals (prior authorizations) process on the Amerigroup provider website.

We put tools and technology in your hands to make it easy to get care and services. Your Service Plan is an easy-to-use, online tool that helps you stay connected with your service coordinator or case manager. It lets you:

• Get your service coordinator or case manager’s phone number and email address
• Send your service coordinator or case manager secure messages about your diagnoses, goals, medicines, services, and more
• View your goals and objectives
• Check due dates and status for goals and objectives

To use this tool:

• Choose Continue to your Service Plan below
• Log in or register first if you don't have an account