Texas Medicaid covered services for seniors 65 and older go well beyond basic doctor visits. If your parent or loved one qualifies through STAR+PLUS, they get prescription drugs, hospital stays, behavioral health care, vision, personal attendant services, and more, all with zero copays. The tricky part is knowing exactly what's included, what's limited (dental, we're looking at you), and how to actually use these benefits without hitting a wall.
In This Guide
- Key Takeaways
- Texas Medicaid Covered Services
- Prescription Drug Coverage
- Dental Coverage (Limited)
- Vision and Hearing
- Behavioral and Mental Health
- Rides to Your Appointments
- Telehealth
- Personal Care and Long-Term Services
- What Medicaid Doesn't Cover
- Prior Authorization: When You Need Approval First
- How to Find a Doctor Who Takes Medicaid
- What to Do If a Service Is Denied
- Frequently Asked Questions
- Next Steps
Key Takeaways
- Zero copays. STAR+PLUS members don't pay copays for covered services, including doctor visits, hospital stays, and prescriptions.
- Prescriptions are covered through the Texas Vendor Drug Program formulary with no copays. Some medications require prior authorization.
- Dental is limited for adults. Base Medicaid primarily covers emergencies, but your MCO may offer $250-$750/year in value-added dental for routine care.
- Free rides to medical appointments through the Medical Transportation Program. Call 877-MED-TRIP at least 2 days ahead.
- Telehealth is available for mental health, therapy, and select services by video, phone, or remote monitoring.
Texas Medicaid Covered Services
Most Texas seniors on Medicaid receive their care through STAR+PLUS, the state's managed care program for adults with disabilities or age 65+. Here's what's covered.
Doctor Visits and Preventive Care
STAR+PLUS covers primary care physician visits, specialist appointments, annual wellness exams, and preventive screenings. You choose a primary care provider (PCP) when you enroll in your MCO, and they coordinate your care from there.
Hospital Care
Inpatient and outpatient hospital services are fully covered. You pay nothing for a hospital stay. Emergency room visits are covered without prior authorization, even at out-of-network facilities.
Lab Work and Imaging
Blood tests, x-rays, MRIs, CT scans, and other diagnostic services are covered when ordered by your provider.
Therapy Services
Physical therapy, occupational therapy, and speech-language therapy are covered under STAR+PLUS. For members on the HCBS waiver, therapy services are part of the expanded benefit package. These services are also available via telehealth.
Not sure what your plan covers? Ask Brevy's chatbot to check your specific benefits -- it only takes a few minutes.
Prescription Drug Coverage
Texas Medicaid covers prescription medications through the Vendor Drug Program (VDP). The VDP maintains a statewide formulary, and the Preferred Drug List gets updated twice a year based on the Drug Utilization Review Board's recommendations.
What You Need to Know
- No copays on covered medications.
- Preferred drugs are covered automatically. Non-preferred drugs may need prior authorization from your doctor.
- Generic drugs are dispensed when available. Your doctor can request brand-name if there's a medical reason.
- Pick up at any network pharmacy, or get medications delivered by mail order or home delivery at no cost.
- Check the formulary before your appointment. The Formulary Drug Search tells you whether your medication is covered and if it needs prior auth.
Having your medication list ready when you see a new doctor saves everyone time. If a drug you need isn't on the formulary, your doctor can submit a prior authorization request to the MCO.
Dental Coverage (Limited)
This is where Texas Medicaid falls short for adults. Unlike coverage for children (which is thorough), adult dental coverage under base Medicaid is mostly limited to emergency care and extractions.
What Your MCO Adds
The good news: STAR+PLUS MCOs offer value-added dental benefits on top of the base coverage. These vary by plan and service area:
- Superior HealthPlan: $250-$750 per year (varies by region) for exams, cleanings, fluoride treatments, and extractions
- UnitedHealthcare: Up to $500 per year for routine dental including exams, cleanings, and x-rays
HCBS Waiver Dental
If you're on the STAR+PLUS HCBS waiver, dental coverage is significantly better. The waiver includes dental services with an annual cap of $5,000 per service plan year. Your MCO can waive this cap if oral surgery is needed.
What's Not Covered
Cosmetic dentistry (whitening, veneers) is never covered. Dental implants are generally not covered under standard Medicaid. Routine preventive dental beyond your MCO's value-added allowance isn't covered under base STAR+PLUS.
Need help figuring out your dental benefits? Chat with Brevy for a breakdown of what your MCO covers.
Vision and Hearing
Vision
STAR+PLUS covers eye exams and Medicaid-covered eyeglasses or contacts. On top of that, MCOs offer value-added vision benefits:
- UnitedHealthcare: Up to $105 for eyeglass frame upgrades
- Superior HealthPlan: Up to $150 per year for upgraded frames, lenses, or contacts
Hearing
Hearing tests, fittings, and hearing aid dispensing are covered. UnitedHealthcare also provides a second hearing aid at no cost for eligible members. If you suspect hearing loss, ask your PCP for a referral to an audiologist within your MCO's network.
Behavioral and Mental Health
STAR+PLUS covers behavioral health services: mental health treatment, counseling, substance use treatment, and 24/7 crisis support. Most MCOs deliver behavioral health through a designated network, so ask your plan which providers are in-network before scheduling.
For UnitedHealthcare members, call 888-887-9003 for behavioral health referrals. Many behavioral health services are available via telehealth, including audio-only visits with your therapist.
MCOs also offer online mental health resources. Superior HealthPlan includes access to telehealth platforms for behavioral health, and UnitedHealthcare provides LiveandWorkWell.com for articles and self-help tools.
Rides to Your Appointments
Can't get to the doctor? Texas Medicaid covers that. The Medical Transportation Program (MTP) provides free non-emergency rides to any covered healthcare appointment.
How It Works
- Call 877-MED-TRIP (877-633-8747) at least 2 business days before your appointment
- Rides cover trips to doctors, dentists, hospitals, pharmacies, and any location providing covered health services
- Your STAR+PLUS MCO may also arrange rides directly. UnitedHealthcare uses SafeRide Health for medical transportation.
This benefit is underused. Many families don't know it exists, and it can be the difference between making an appointment and missing one. If your parent lives alone and doesn't drive, put 877-MED-TRIP in their phone.
Telehealth
Texas Medicaid covers telehealth through four methods: live video visits, audio-only phone calls, store-and-forward (sending images or data for later review), and remote patient monitoring.
Services available via telehealth include mental health counseling, physical therapy, occupational therapy, speech therapy, and crisis intervention. There are no geographic restrictions, so your parent can see a provider from home.
For behavioral health audio-only visits, the provider needs informed consent from the patient or their authorized representative before the appointment.
Personal Care and Long-Term Services
Beyond medical care, STAR+PLUS covers long-term services and supports (LTSS) that help seniors stay at home:
- Personal attendant services (PAS) for help with bathing, dressing, grooming, eating, and household tasks
- Day activity and health services for supervised group care with nursing support
For seniors who need more help, Community Attendant Services (CAS) provides up to 50 hours per week of personal care with no waitlist.
The STAR+PLUS HCBS waiver adds even more: in-home nursing, respite care, home-delivered meals, home modifications, emergency response systems, assisted living, and therapies. But the waiver has approximately 15,850 people on its interest list.
Want help understanding which long-term care program fits? Chat with Brevy for a personalized recommendation based on your family's needs.
What Medicaid Doesn't Cover
A few things Texas Medicaid won't pay for:
- Cosmetic procedures including cosmetic dentistry, elective cosmetic surgery
- Routine adult dental beyond emergency services and your MCO's value-added allowance (under base STAR+PLUS)
- Dental implants under standard coverage
- Private duty nursing beyond what's authorized in your care plan
- Experimental treatments not yet approved by the FDA
- Out-of-network care without prior authorization (except emergencies)
- Services outside Texas except in border areas with arrangements with neighboring states (Louisiana, Arkansas, Oklahoma, New Mexico) for the Medical Transportation Program
If you're unsure whether something is covered, call your MCO's member services line before the appointment. Getting a "no" after the fact is worse than checking first.
Prior Authorization: When You Need Approval First
Some services need your MCO's approval before you can get them. This is called prior authorization (PA), and it's your provider's job to request it.
Services That Typically Need Prior Auth
- Bariatric surgery
- Certain cardiology procedures (diagnostic catheterizations, implants)
- Chemotherapy and oncology drugs
- Select specialty medications (non-preferred drugs)
- Certain durable medical equipment
- Non-emergency inpatient hospital admissions
- Some outpatient surgical procedures
What Doesn't Need Prior Auth
- Emergency care (never needs prior auth, even out-of-network)
- Urgent care
- Routine primary care visits
- Preventive screenings
How Fast Your MCO Must Decide
Federal rules effective in 2026 require MCOs to process prior authorization requests within 7 calendar days for standard requests and 72 hours for urgent requests. If your MCO misses these deadlines, the request is typically approved automatically.
How to Find a Doctor Who Takes Medicaid
Finding a provider who accepts Texas Medicaid starts with your MCO. Each STAR+PLUS MCO maintains its own provider directory:
- Superior HealthPlan: Find a Provider online tool or call member services
- UnitedHealthcare: Call 1-888-887-9003 or use the online provider search
- Other MCOs: Check your member ID card for the phone number and website
You can also call the HHSC Enrollment Broker at 1-800-964-2777 for help choosing or switching MCOs if your current plan doesn't have enough providers in your area. And 2-1-1 Texas can point you to Medicaid assistance in your county.
Calling ahead to confirm a provider still accepts your specific MCO plan is worth the two minutes. Provider directories aren't always current.
What to Do If a Service Is Denied
If your MCO denies, reduces, or cuts a service, you have the right to fight it.
Step 1: Appeal to Your MCO
File an internal appeal within 60 calendar days of the denial notice. You can do this verbally, in person, or in writing. The MCO has 30 calendar days to decide.
Step 2: Request a State Fair Hearing
If the MCO upholds the denial, you have 120 days to request a State Fair Hearing through HHSC. These are typically held by conference call. HHSC has 90 days to issue a decision.
Keep Your Services Running
You can request that services continue at their current level while your appeal or hearing is pending. If the decision goes against you, you may need to repay those costs, but for most families the continuity of care is worth it.
The HHSC Ombudsman line at 1-866-566-8989 handles managed care complaints and can help you understand your options.
Have questions about a service denial? Brevy's chatbot can walk you through the appeal process.
Frequently Asked Questions
Adult dental coverage under base Texas Medicaid is limited to emergency services and extractions. However, STAR+PLUS MCOs add value-added dental benefits ranging from $250 to $750 per year for routine care like exams and cleanings. Members on the HCBS waiver get dental coverage up to $5,000 per year.
No. STAR+PLUS members pay zero copays for all covered services, including doctor visits, hospital care, and prescription drugs.
Yes. Texas Medicaid covers telehealth visits by live video, audio-only phone calls, and remote monitoring. Mental health services, therapy (PT, OT, speech), and crisis support are all available via telehealth with no geographic restrictions.
Call 877-MED-TRIP (877-633-8747) at least 2 business days before your appointment. The Medical Transportation Program provides free rides to any covered healthcare appointment for Medicaid members who have no other transportation.
Next Steps
Now that you know what Texas Medicaid covers, here's where to go from here:
- Check if you qualify: Read our guide to applying for Texas Medicaid for the step-by-step process
- Compare programs: Our overview of Texas Medicaid programs for seniors covers STAR+PLUS, CAS, HCBS waivers, and PACE side by side
- Learn about the HCBS waiver: If your loved one needs more than base STAR+PLUS, our STAR+PLUS waiver guide explains what's covered and how to get on the list
- Explore caregiver pay: Family members may qualify to get paid for caregiving through Medicaid. See our guide to getting paid as a family caregiver in Texas
- Get personalized help: Find home health care near you at brevy.com
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.