Texas STAR+PLUS benefits

STAR+PLUS is a Texas Medicaid managed care program for adults who have disabilities or are ages 65 or older.

Medical care is just the beginning

With Wellpoint, you’ll also have access to a wide range of services including long-term services and supports, vision care, and extra benefits like our Healthy Rewards program.

Not sure of your service area?

Visit our Know Your Service Area page.

There are no copays for covered services.

Primary care provider 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 use disorder services)

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

Check your STAR+PLUS member handbook for a complete list of benefits.

If you're a Home and Community Based Services (HCBS) 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 STAR+PLUS Waiver (SPW) member, only emergency dental services are covered.
Check the Extra Benefits page for any dental value-added benefits that may be offered.

You can get no-cost rides to your health care services. Wellpoint will provide rides to the doctor, dentist, hospital, pharmacy, and any other place you receive Medicaid services. Call us at least two business 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 business days before you need a ride.

Wellpoint will use Access2Care to arrange all travel. Call 844-867-2837 (TTY 711) to schedule a ride or visit the Transportation page for more details.

Transportation benefits are limited for nursing facility members.

Healthy Rewards* is a program that pays you for taking control of your health. You can earn rewards for completing healthy activities like:

Diabetic A1c blood sugar screenings.
Cervical cancer screenings.
Flu vaccine.

*Members with Medicare are not eligible for Healthy Rewards.

Then redeem your Healthy Rewards via the Benefit Reward Hub. To learn about other value-added benefits, visit the Extra Benefits page.

Service coordination helps you get the care and services you need. A service coordinator will:

Visit you at your home to learn about your health needs and goals and help create your service plan.
Help you make appointments to visit 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 help take charge of your care, so you can stay healthy and live independently.

If you think you need a service coordinator or if you’d like to speak with one, call Member Services at 833-731-2160 (TTY 711).

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. We can also mail your Service Plan materials to your home. Your Service Plan lets you:

Get your service coordinator’s phone number and email address
Send your service coordinator 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

Continue to Your Service Plan

STAR+PLUS nursing facility members

If you live in a nursing facility, most of your care will come from the nursing facility. Your Service Plan helps you stay connected with your service coordinator. You can access your Service Plan online, or have the materials mailed to you. You can also talk to your service coordinator about your services. Services include:

Daily care services such as:

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

You pay nothing for STAR+PLUS benefits 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.

Preapprovals and referrals

Preapprovals

A preapproval is when your doctor needs to ask us to approve a service before you receive it. Your provider will work with us to get the preapprovals you need. Please refer to the Referrals and Preapprovals page.

Referrals

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

The member handbook: Everything you need to know

Your member handbook is your go-to guide for health services. Read it to find out about:

How to use your benefits.

How to choose a primary care provider.

How to get help if your doctor's office is closed.

How to reach Member Services if you have questions.

Your rights and responsibilities as a Wellpoint member.

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)

Need a handbook mailed to you?

Request a handbook via live chat with Member Services. To have a STAR+PLUS member handbook mailed to you at no cost, contact Member Services. The handbook will be mailed within five business days of your request.