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    • Aetna Better Health® of Texas

    What's covered?

    Apply or renew

    For members

    Health and wellness

    Frequently asked questions

    Have a question?

    Just contact us.

    Just contact us.

    General questions

    • Medicaid is a program that provides health care for millions of Americans. In Texas, it’s called STAR. It covers low-income adults, children, pregnant women and people with disabilities. If you qualify, you can get coverage for things like:

       

      • Preventive care 

      • Vision care

      • Dental care

      • Medications 

      • Disease management

      • Behavioral health services 

      What is STAR?

      STAR is Medicaid coverage for kids, newborns, pregnant women and some families.

       

      What is STAR Kids?

      STAR Kids is Medicaid coverage for kids and adults ages 20 or younger who have disabilities.  

       

      More questions and answers about STAR Kids English (PDF) | Spanish (PDF)

       

      What are CHIP and CHIP Perinatal?

      CHIP offers coverage for families that earn too much money to use Medicaid, but can’t afford to buy private health insurance. CHIP Perinatal offers coverage for mothers-to-be.  

       

      Find out if you qualify

    • Before you can get coverage, be sure you qualify for Medicaid or CHIP.

       

      If you qualify, you can choose Aetna Better Health as your health plan in your Medicaid application.

       

      You can also read the answers to 10 common questions about qualifying for Medicaid.

       

      Learn more about how to enroll

    • Yes. To keep your coverage, you must renew every year.

       

      Learn more about how to renew your coverage

    • We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a complaint. Or you can file an appeal if we deny, delay or change a service. If you don’t agree with the decision on your appeal, you can ask for an external medical review or state fair hearing.

       

      Learn more about filing a complaint or an appeal

    • Tell us. You have the right to report anyone you believe is committing fraud or abusing the Medicaid system. You can use this form to report fraud or abuse. Your identity and contact info will be kept private to the extent the law allows. 

       

      Learn more about fraud or abuse

    Member Services

    • You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal. 

       

      Log in to the Member Portal

       

      You can also check your specific plan online:

       

      STAR

      STAR is Medicaid coverage for kids, newborns, pregnant women and some families. 

       

      STAR Kids 

      STAR Kids is Medicaid coverage for kids and adults ages 20 or younger who have disabilities.  

       

      More questions and answers about STAR Kids English (PDF) | Spanish (PDF)

       

      CHIP and CHIP Perinatal 

      CHIP offers coverage for families that earn too much money to use Medicaid, but can’t afford to buy private health insurance. CHIP Perinatal offers coverage for mothers-to-be.  

    • We have different helplines, depending on your plan and where you live. Just visit our contact us page for hours, services and service areas. 

       

      You can also log in to your Member Portal.

    • Just log in to your Member Portal to ask for a new ID card. Or contact us.

    My health care providers

    • Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse or clinic that provides your main health care. They’ll help you get all the covered services you need.

    • You can change your PCP through your Member Portal. Or just contact us.

       

      You can also learn more about choosing a PCP.

       

      Log in to the Member Portal

    • Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

       

      Log in to the Member Portal

    • Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network or recommend you see one. You don’t need a referral to see a specialist.

       

      Need help finding a specialist? Just contact us.

       

      Find a specialist near you

    • You can find providers for the health care services you need. 

       

      Find a provider

    • Call the provider’s office and let them know you have Aetna Better Health. Providers can’t bill or collect any amount from you for covered health care services. This is in your provider’s contract. If you get a bill or have questions, just contact us.

    Coverage and care

    • Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

    • If you're having an emergency, call 911 or go to the closest hospital.

       

      You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

       

      • Severe pain
      • Serious injury
      • Sudden illness
      • Illness that is quickly getting much worse
      • Heavy bleeding that doesn’t stop, especially if you’re pregnant

      If it’s not an emergency, but you need medical advice, try calling your PCP. You can leave a message with the answering service. A provider on call will return your call.

       

      Still not sure what to do? You can also contact us. When prompted on the phone, say, “nurse line.” A nurse can help you decide if you need to go to the ER or urgent care.

       

      STAR

       

      STAR Kids

       

      CHIP and CHIP Perinatal

       

      Find the closest hospital

       

      Check out some of these articles to learn more about getting the right care at the right time:

       

    • If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members. 

       

      Need a ride to your normal doctor visits? You can get help with rides to medical services we cover. We work with Access2Care to provide rides for your nonemergency medical needs. You can get a ride for visits to your:

       

      • Provider 
      • Dental provider
      • Pharmacy
      • Behavioral health care provider 

      Learn more about covered rides

    • If you’re out of the area and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for you to get care.

    • We work with many hospitals. You can use the provider search tool to find a hospital. Or you can contact us for help.

    • Pregnant women need special care. You should see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just contact us as soon as you can.

       

      You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

       

    • You’ll want to make sure your baby has medical coverage. If you don’t have insurance when your baby is born, you’ll want to enroll them in Texas Medicaid. Just contact the Department of State Health Services (DSHS) as soon as possible. Call 1-888-963-7111 (TTY: 711) Monday to Friday, 8 AM to 5 PM. Then, your baby can get an ID number and be eligible for benefits. 

       

       

       

      If you have questions or need help, just contact us.

       

       

      Learn about rewards for pregnancy and birth care

       

    • If you are breastfeeding or would like to, we can help. Visit https://book.nestcollaborative.com/2?partner=abh

       

      WIC phone lines may be busy. WIC has made changes to how you can use your WIC card. You can also check their website for new formula types and can sizes to meet your baby's needs. Visit https://texaswic.org/about-wic/special-wic-food-updates

       

      Do not mix formula differently to make it last longer. Follow the directions on the can or bottle. Talk to a doctor before you change how you make your baby's formula

       

      Some formula was stopped by the formula maker (recalled). Some names are Similac, Alimentum, and EleCare. You should check to see if the formula you have is safe to use. If you have questions you can contact the formula make (Similacrecall.com)

       

      You may get your formula delivered by a company. If you having problems, please contact them or let us know. We have changed our rules to make it easier for you to get a different formula. 

       

    • When you have a condition, you’ll work with your health care provider to set up a treatment plan. The plan will likely include certain steps, like:

       

      • Taking medication
      • Making lifestyle changes, like eating and exercise
      • Finding emotional support

       

      Some conditions can benefit from disease management, like:

       

      • Asthma
      • Chronic obstructive pulmonary disease (COPD)
      • Diabetes
      • Heart failure
      • Coronary artery disease (CAD)
      • Depression

       

      Do you have one of these conditions? If yes, you may be able to get help from a care manager. Just contact us to learn more.

       

      You can also visit our page on disease management.

    • Just contact us. We’re here to help.

    • Check your member ID card from your dental plan. Then, call your plan for answers to your questions:

       

    • Referrals

      A referral is an approval from your PCP for you to get covered specialty care and follow-up treatment. You don’t need a referral to see in-network providers for routine and preventive health care services. You don’t need a referral to see a specialist, either.

       

      PA

      You do need PA for some health care services, supplies and medications before you get them. We use nationally recognized guidelines to make PA decisions about care your provider suggests.

       

      Your provider must check to see if your service requires PA before they provide it. To ask for the current PA list, just contact us.

       

      Learn more about PA

       

      PA timelines

      We review pharmacy requests and make a decision within:

       

      • 24 hours for STAR and STAR Kids members
      • 3 business days for CHIP and CHIP Perinatal members

       

      You can learn more about PA timelines.

    Pharmacy

    • A PDL is a state-run list of medications that a health plan covers. These medications treat a variety of conditions.

       

      Learn more on our pharmacy benefits page

    • You can ask your provider:

       

      • To give you a similar medication that is preferred on the list
      • To get prior authorization (PA) to cover this medication if they think it’s necessary to treat your medical condition

    • First, your provider will contact us. Then, our pharmacy staff will review the info your provider gave us. Finally, we’ll make a decision. 

    • Some health care services and supplies need approval before you can get them. We follow nationally recognized guidelines to make these decisions. Not sure if a service needs PA? Just contact us for the most current PA list. Before providing a service, your provider should check the list. It may change from time to time. 

    • We work with the state to set quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. Our clinical staff sets the limits based on proven standards of care, such as the Food and Drug Administration (FDA) guidelines. In some cases, we make exceptions. Have your provider contact us if you need an exception. We’ll review the info from your provider and make a decision.

    • These types of medications aren’t covered on the PDL:

       

      • Cosmetic 

      • Hair growth

      • Infertility or erectile dysfunction 

      • Experimental or investigational 

    Physical and behavioral health

    Also of interest: