If your parent just qualified for Texas Medicaid, one of the first decisions is picking a managed care plan. Seven MCOs run the STAR+PLUS program, but not all of them serve every part of the state. Which Texas Medicaid managed care plans are available to you depends on where you live. This guide covers who the MCOs are, which ones serve your area, and what actually matters when you're comparing them.
In This Guide
- Key Takeaways
- What Is a Managed Care Plan?
- The Seven STAR+PLUS MCOs
- Which MCOs Serve Your Area
- How to Compare Plans
- What Happens If You Don't Choose
- How to Switch Your MCO
- Your Rights as a Member
- What to Do If You Have a Problem
- Frequently Asked Questions
- Next Steps
Key Takeaways
- Seven MCOs serve STAR+PLUS: United Healthcare, Molina, Superior HealthPlan, Wellpoint (Amerigroup), Community First, El Paso Health, and Community Health Choice.
- Your options depend on your area. Texas has 13 service delivery areas, each with 2-3 MCOs to choose from.
- You can switch at any time by calling the Enrollment Broker at 1-800-964-2777. Changes take 15-45 days.
- Check if your doctor is in-network before choosing. That's the single most important factor for most families.
- Zero copays regardless of which MCO you pick. All STAR+PLUS plans cover the same core services.
What Is a Managed Care Plan?
Almost all Texas Medicaid seniors get their care through managed care, not the old fee-for-service system. Your MCO (managed care organization) is the health plan that coordinates and pays for your medical care. Think of it as the middleman between you and your doctors.
Every STAR+PLUS MCO covers the same core Medicaid benefits: doctor visits, hospital care, prescriptions, behavioral health, vision, personal attendant services, and long-term care. The differences are in their provider networks, customer service, and the extra "value-added" benefits they offer on top.
The Seven STAR+PLUS MCOs
Here's who's running STAR+PLUS as of September 2024:
United Healthcare Community Plan. The largest national Medicaid MCO. Strong statewide presence across 9 of 13 SDAs. Offers SafeRide Health transportation, $500/year dental allowance, $105 vision frame upgrade, second hearing aid at no cost, and pharmacy home delivery.
Molina Healthcare of Texas. Serves 9 SDAs. Known for strong provider networks in urban areas.
Superior HealthPlan. Long-standing Texas MCO, serves 9 SDAs. Offers $250-$750/year dental (varies by area), $150/year vision allowance, and Weight Watchers subscriptions.
Wellpoint (formerly Amerigroup). Serves 4 SDAs in Lubbock, Nueces, Jefferson, and West Texas.
Community First Health Plans. San Antonio area only (Bexar SDA). Regional plan with deep local roots.
El Paso Health. El Paso SDA only. Local plan focused on the border region.
Community Health Choice. Houston area only (Harris SDA). Community-focused plan for the Houston metro.
Not sure which plan is right for your family? Ask Brevy's chatbot to compare MCOs in your area.
Which MCOs Serve Your Area
Texas is divided into 13 service delivery areas for STAR+PLUS. Here's which MCOs operate in each:
| Service Area | Region | MCOs Available |
|---|---|---|
| Bexar | San Antonio | Community First, Molina, United Healthcare |
| Dallas | Dallas metro | Molina, Superior, United Healthcare |
| El Paso | El Paso | El Paso Health, Molina |
| Harris | Houston metro | Community Health Choice, Molina, United Healthcare |
| Hidalgo | Rio Grande Valley | Molina, Superior, United Healthcare |
| Jefferson | Beaumont/SE Texas | Molina, Wellpoint |
| Lubbock | Lubbock area | Superior, Wellpoint |
| Nueces | Corpus Christi | Superior, Wellpoint |
| Tarrant | Fort Worth | Molina, United Healthcare |
| Travis | Austin | Superior, United Healthcare |
| MRSA Central | Central Texas (rural) | Superior, United Healthcare |
| MRSA Northeast | NE Texas (rural) | Molina, United Healthcare |
| MRSA West | West Texas (rural) | Superior, Wellpoint |
Three MCOs changed or entered new areas on September 1, 2024, so if you enrolled before that date, your MCO options may have shifted. Call the Enrollment Broker at 1-800-964-2777 to confirm what's available now.
How to Compare Plans
All STAR+PLUS MCOs cover the same core Medicaid services. So what actually differentiates them?
1. Is Your Doctor In-Network?
This is the question. If your parent has a primary care doctor, specialist, or home health agency they trust, check whether that provider is in the MCO's network before choosing. Every MCO maintains a provider directory:
- Call the MCO's member services line (on the back of the member ID card)
- Use the MCO's online "Find a Provider" tool
- Call the provider's office directly and ask which STAR+PLUS plans they accept
2. Value-Added Benefits
MCOs compete on extras. These vary by plan and by service area:
| Benefit | United Healthcare | Superior | Molina | Others |
|---|---|---|---|---|
| Dental allowance | Up to $500/yr | $250-$750/yr | Varies | Varies |
| Vision frame upgrade | $105/yr | $150/yr | Varies | Varies |
| Transportation | SafeRide Health | MCO-arranged | MCO-arranged | MCO-arranged |
| Extra hearing aid | Yes | No | Varies | Varies |
| Pharmacy delivery | Free home delivery | Available | Available | Available |
3. Customer Service Quality
HHSC publishes managed care report cards comparing MCOs on member satisfaction, access to care, and quality metrics. Check the latest report card before choosing.
4. Service Coordinator Responsiveness
Every STAR+PLUS member gets a service coordinator from their MCO who manages their care. Some MCOs are better than others at assigning coordinators quickly and keeping them available. Ask other families in your area about their experience.
What Happens If You Don't Choose
If you don't pick an MCO within the enrollment window, HHSC auto-assigns one for you. The auto-assignment algorithm considers factors like existing provider relationships and plan capacity, but it's not guaranteed to pick the best fit.
You're better off choosing actively. Even a quick check of whether your current doctor is in-network is more useful than being randomly assigned.
Need help comparing MCOs in your service area? Chat with Brevy to find out which plans your providers accept.
How to Switch Your MCO
Not happy with your plan? You can change.
- Call the Enrollment Broker at 1-800-964-2777 (8am-6pm CT, Monday-Friday)
- You can switch MCOs at any time for Texas Medicaid (unlike CHIP, which restricts changes)
- Changes take 15-45 days to process
- Within the first 90 days of enrollment, you have an unrestricted right to change without cause
The Enrollment Broker provides free, independent counseling to help you compare plans. They're not affiliated with any MCO.
If your parent's doctor leaves their MCO's network mid-year, that's a valid reason to switch. Continuity of care protections may also let them keep seeing that doctor temporarily while the switch processes.
Your Rights as a Member
Regardless of which MCO you choose, you have the right to:
- Choose your PCP. You pick your primary care provider, and you can change PCPs within your MCO at any time.
- See a specialist. Your PCP can refer you to specialists within the MCO network. Some specialists don't need a referral.
- Get a second opinion. You can request a second opinion from another in-network provider at no cost.
- Emergency care anywhere. Emergency rooms must treat you regardless of network status. No prior authorization needed.
- Language access. MCOs must provide interpreter services and translated materials at no cost.
- File a complaint. You can file a grievance with your MCO or directly with HHSC.
- Appeal denials. If your MCO denies a service, you have the right to appeal and request a state fair hearing.
What to Do If You Have a Problem
File a Complaint with Your MCO
Every MCO has a grievance process. Call the member services number on your ID card and ask to file a formal complaint. The MCO must acknowledge it within 5 business days and resolve it within 30 days.
Contact HHSC
If the MCO doesn't resolve your issue, contact HHSC directly:
- HHSC Ombudsman Managed Care Helpline: 1-866-566-8989
- HHSC general line: 1-800-252-8263
- File online through the HHSC complaint form
Request a State Fair Hearing
If your MCO denies, reduces, or terminates a service, you can file an internal appeal within 60 days, then request a State Fair Hearing within 120 days if the MCO upholds the denial. You can request that services continue while the hearing is pending.
Having trouble with your health plan? Brevy's chatbot can explain your options for complaints and appeals.
Can I change my Texas Medicaid health plan?
Yes. STAR+PLUS members can change MCOs at any time by calling the Enrollment Broker at 1-800-964-2777. Changes take 15-45 days. You have an unrestricted right to change within the first 90 days of enrollment.
Do different Texas Medicaid plans cover different services?
All STAR+PLUS MCOs cover the same core Medicaid services (doctor visits, hospital, prescriptions, behavioral health, vision, attendant services). The differences are in provider networks, customer service, and value-added extras like dental allowances and vision upgrades.
What if my doctor doesn't accept my MCO?
You have two options: switch to an MCO that includes your doctor (call 1-800-964-2777), or ask your MCO about continuity of care provisions that may allow temporary out-of-network access. For a new enrollment, check the provider directory before choosing your plan.
How many MCOs can I choose from?
It depends on your service area. Most areas have 2-3 MCOs. Major metros (Houston, Dallas, San Antonio) have 3 options. Smaller areas typically have 2.
Next Steps
- See what's covered: Our guide to Texas Medicaid covered services explains benefits across all MCOs
- Compare all programs: Our overview of Texas Medicaid programs for seniors covers STAR+PLUS, CAS, HCBS waivers, and PACE
- Learn about the HCBS waiver: If your loved one needs more than base STAR+PLUS, read our HCBS waiver guide
- Apply for Medicaid: Start with our step-by-step application guide
- 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.