What STAR+PLUS does
STAR+PLUS is run by health plans, called managed care organizations, that contract with HHSC. It's the Texas Medicaid program for adults who are 65 or older or who have a disability. It covers two kinds of care:
- Health care such as checkups, medicine, hospital care, lab tests and X-rays, vision and hearing care, and mental health care. If you have Medicare, Medicare covers most of these first.
- Long-term services and supports, which Medicare generally doesn't cover: personal assistance services, Day Activity and Health Services, emergency response services, habilitation and Community First Choice.
People who qualify for the STAR+PLUS Home and Community-Based Services program can also get services such as adaptive aids, assisted living, home-delivered meals, minor home modifications, nursing, respite care and therapies.
How STAR+PLUS works with Medicare
Many STAR+PLUS members also have Medicare. HHSC says STAR+PLUS doesn't change the way you get Medicare services. In practice:
- Medicare (Original Medicare or a Medicare plan) pays for your doctor visits, hospital stays and prescriptions.
- Your STAR+PLUS health plan covers Medicaid services, especially long-term services and supports, and coordinates your care.
- You can still choose how you get Medicare. See can I have STAR+PLUS and Medicare Advantage.
Who qualifies
You must first be approved for Medicaid. Then HHSC lists groups that join STAR+PLUS, including adults 21 or older who get SSI, adults who need STAR+PLUS Home and Community-Based Services, adults covered through Social Security exclusion programs who meet income and asset rules, and adults on Medicaid in a nursing home. People who get services through certain other Medicaid waivers, or who live in facilities for people with intellectual or developmental disabilities, aren't in STAR+PLUS.
Not sure you qualify for full Medicaid? You may still qualify for a Medicare Savings Program, which pays Medicare premiums. See does Texas Medicaid pay Medicare premiums.
How to apply
Apply for Medicaid at YourTexasBenefits.com or by calling 2-1-1. HHSC publishes charts comparing the extra services each STAR+PLUS plan offers in each service area.
Get help
If you have Medicare and STAR+PLUS, a licensed insurance agent with Benefits Life can explain your Medicare choices, including special needs plans for people with both Medicare and Medicaid, from the companies they work with, at no cost to you, at (512) 265-6565, TTY 711. See Texas Medicaid and Medicare.
Related questions
Can I have STAR+PLUS and Medicare Advantage?
Your Medicare choices as a dual eligible.
Does Texas Medicaid pay Medicare premiums?
The four Medicare Savings Programs.
Does Medicare cover dental in Texas?
What Medicare and Medicaid cover.
Sources
- Texas HHSC — STAR+PLUS
- Texas HHSC — Options for Medicare and Medicaid dual coverage
- Your Texas Benefits (HHSC)
Frequently asked questions
Who can join STAR+PLUS?
You must be approved for Texas Medicaid and fit one of HHSC's groups, such as adults 21 or older who get SSI, adults who need STAR+PLUS Home and Community-Based Services, adults who qualify through Social Security exclusion programs, and adults on Medicaid in a nursing home. Most people with both Medicare and Medicaid can join.
Does STAR+PLUS replace Medicare?
No. HHSC says that if you have both Medicare and Medicaid and join STAR+PLUS, you keep getting regular health care through your Medicare doctor. Medicare pays first for Medicare-covered care, and STAR+PLUS covers Medicaid services such as long-term services and supports.
How do I apply for STAR+PLUS?
Apply for Medicaid online at YourTexasBenefits.com or by calling 2-1-1. Once you're approved, you choose a STAR+PLUS health plan that serves your area.
What is a service coordinator?
Every STAR+PLUS member gets service coordination. HHSC says a service coordinator visits within 30 days after you enroll and at least once a year, and helps arrange the services you need.
Medicare in your Texas county
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