If your loved one has Medicaid but not Medicare — or has both — you've likely heard the term "STAR+PLUS" and wondered what it actually covers. It's one of the most misunderstood parts of Texas's health system, and it's different enough from Medicare that families often miss benefits they're already entitled to.
What Is STAR+PLUS?
STAR+PLUS is the Texas Medicaid managed care program for adults who are 65+, or who have a disability, and either qualify for Medicaid alone or for both Medicare and Medicaid ("dual-eligible"). Instead of billing Medicaid directly, care is coordinated through a Managed Care Organization (MCO) — companies like Superior HealthPlan, Molina Healthcare, Amerigroup, or United Healthcare Community Plan, depending on your service area.
Who Qualifies?
- Age 65 or older and enrolled in Medicaid
- Adults with a qualifying disability, regardless of age
- Dual-eligible individuals (both Medicare and Medicaid)
- Meet a Bexar County service-area MCO's enrollment criteria
What Does STAR+PLUS Cover That Medicare Doesn't?
This is where it matters most for families: STAR+PLUS includes long-term services and supports (LTSS) — the personal, day-to-day care that Medicare explicitly excludes.
- Personal care services — bathing, dressing, mobility assistance, meal prep
- Skilled nursing and home health aide visits
- Respite care to give family caregivers a break
- Home modifications (ramps, grab bars) in some cases
- Day activity and health services
STAR+PLUS vs. Medicare Home Health: The Key Difference
Medicare home health requires a skilled need (nursing, therapy) and covers care in short, intermittent episodes. STAR+PLUS is built for ongoing support — including help that isn't medical, like bathing or getting dressed — which is exactly the gap most families hit once Medicare's skilled-care episode ends but daily help is still needed.
How to Apply
- Confirm Medicaid eligibility through Texas Health and Human Services (apply at yourtexasbenefits.com if you haven't already)
- Once approved, you'll select or be assigned an MCO serving Bexar County
- A service coordinator from your MCO completes a needs assessment
- Your care plan — including home health and personal care hours — is built based on that assessment
The process can take several weeks, and paperwork is often the biggest obstacle — not eligibility itself. Associates Home Health works with STAR+PLUS patients across all the major Bexar County MCOs and can help your family understand what's realistically available before you start the application.
A Real Example
The Ramirez family had been paying privately for a caregiver to help their mother with bathing and meal prep for over a year, not realizing she qualified for STAR+PLUS as a dual-eligible senior. Once enrolled through her MCO and assessed, her care plan covered personal care hours that Medicare had never touched — cutting the family's out-of-pocket costs substantially and adding respite hours they hadn't known to ask for.
Frequently Asked Questions
Yes — this is called being "dual-eligible," and it's common. Medicare covers skilled, short-term care; STAR+PLUS covers the ongoing personal care Medicare doesn't, so together they often provide more complete coverage than either alone.
The major MCOs serving Bexar County — Superior HealthPlan, Molina, Amerigroup, and United Healthcare Community Plan — all cover the same core STAR+PLUS benefits, but provider networks and extra benefits can differ. Our team can tell you which plans we're in-network with directly.
Typically several weeks from Medicaid approval to a completed needs assessment and care plan. Gathering documentation early — income verification, medical records — is the biggest way to avoid delays.
No — STAR+PLUS covers a set number of authorized hours per week based on your assessed needs, not round-the-clock supervision. For families needing more than their authorized hours, private pay or long-term care insurance typically fills the gap.
Denials can often be appealed, and many are the result of missing documentation rather than genuine ineligibility. Our team can help you understand the specific reason for a denial and what to do next.
Call (210) 541-8707 or use our free insurance verification form — we'll tell you plainly what's covered before anything is submitted.
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