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STAR Medical Benefits

Blue Cross and Blue Shield of Texas wants to make sure you get the health care you need. That’s why we offer benefits and programs to help keep you healthy. From routine care to urgent care, family planning to mental health care, BCBSTX is there for you.

What is Covered?

The table below contains just some of the health care covered by your STAR plan. BCBSTX covers any medically necessary care that Medicaid covers. Some types of care may need to be approved before you are treated. Without approval, BCBSTX will not pay for the service. Learn more about prior authorization.

Covered Service

Needs Prior Authorization?

Coverage

Ambulance Services

No

  • Only covered when ambulance is used for emergency transport.
  • A licensed ambulance company

Diagnostic and Therapeutic Radiology

Some radiology services need an “okay” from us before you get the service. These include CT, MRI, MRA, PET and SPECT.

  • Testing and X-rays that are:
    • not invasive
    • done to find out what is wrong
    • ordered and done by (or under the guidance of) your provider

Doctor Services

No

  • Visits to in-network primary care providers (PCPs), specialists or other health care providers
  • Well exams

Durable Medical Equipment (DME) and Disposable Supplies

Yes

  • Medical equipment that is used in the home
  • Must be within the limits of what is covered by Medicaid

Emergency Services

No

  • Treatment in an emergency room (ER)
  • Ambulance services

Family Planning Services

No

  • Medical visits for birth control
  • Marriage and family planning, education and counseling services
  • Birth control medicines, including long-acting reproductive contraception (LARC)

Home Health Care

Yes

  • Home health aid services
  • Speech therapy
  • Physical therapy visits
  • Occupational therapy visits
  • DME
  • Medical supplies that are thrown away after use

Hospital Services (inpatient)

Yes

  • Hospital room with two or more beds
  • Nursing care
  • Operating room
  • Surgery
  • Anesthesia

Hospital Services (outpatient)

Yes

  • Dialysis
  • Giving you someone else’s blood

Lab Services

Yes

  • All authorized lab services such as blood and urine testing

Pregnancy-related and Maternity Care

No

  • Pregnancy care
  • After-delivery care when medically necessary
  • Newborn exams

Texas Health Steps Medical Checkups

No

  • Routine shots
  • Lab tests
  • Comprehensive Care Program services for members 20 years and under

Urgent Care

No

  • Treatment at an in-network urgent care clinic for an illness or injury that is not an emergency, but should be treated within 24 hours

Check Part 7 of your STAR Member Handbook  to get a full list of what your plan covers.

What Is Not Covered?

Some services that are not covered include:

  • Treatments that are not medically necessary
  • Cosmetic surgery
  • Procedures that are new or still being tested
  • Services received outside of the United States.

GET MORE FROM YOUR PLAN

Value-Added Services

Your plan offers more than just your standard Medicaid benefits. We offer extra services called value-added services (VAS). These services are designed to help keep you and your family healthy.

Check out VAS

MEMBER RESOURCES

Helpful Tools and Resources

Get the information you need. We’re here to help. 

Find Care

Need to search for providers in your area? Or figure out where to go for care?

Find a Provider

Transportation Services

Learn how you can get a no-cost ride to your medical appointments.

Schedule a Ride

Forms and Documents

For details about your plan, check your Member Handbook.

Go to Forms and Documents

Contact Us

If you have questions about your plan, call the Customer Advocate Department.

Get More Help