HealthSpring
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What Are My Benefits?

As a member of HealthSpring’s STAR+PLUS plan, you will have access to a long list of benefits that cover every area of your health care. You will always receive services you need that are medically necessary. Some special services are also available only for people of a certain age or who have certain kinds of health care needs.
Benefits include:

Under HealthSpring, your Primary Care Provider (PCP) can give you most of the care you need or refer you to another physician or provider for more specialized care.

If you have questions about your HealthSpring benefits, you can find out more by calling Member Services 8:00 a.m. – 5:00 p.m. Central Time, Monday through Friday.
 
  • Hidalgo Service Area: 1-877-653-0327 (TTY 711)

  • Tarrant Service Area: 1-877-966-9272 (TTY 711)
 

Service Coordination

Service coordination is a service HealthSpring provides for you. You and your HealthSpring Service Coordinator will work together to assess your health needs. Together you will also create a care plan, organize all your services, and then monitor your progress toward your health care goals. When you enroll with HealthSpring, you will automatically have a Service Coordinator available to you.

You will be able to contact your HealthSpring Service Coordinator by phone with questions and concerns.
  • If you live in the Rio Grande Valley area, call 1-877-725-2688. 

  • If you live in the Fort Worth area, call 1-877-562-4402.
You can also call HealthSpring Member Services at 1-877-966-9272 to contact your Service Coordinator.
  • If you live in the Rio Grande Valley area, call 1-877-653-0327 (TTY 711)

  • If you live in the Fort Worth area, call 1-877-966-9272 (TTY 711)

The HealthSpring Service Coordinator’s job is to help you coordinate all of the services needed to meet your health care needs. A Service Coordinator will help you whether or not your PCP is in HealthSpring’s Network. If you are Dual Eligible (this means you are eligible for both Medicare and Medicaid) you will receive most Acute Care services, including prescription drug services, through Medicare, rather than Medicaid. Your Service Coordinator will:

  • Call you and get to know you and your health care, long-term care, and behavioral health needs

  • Use a health risk assessment to help decide if you need more help right away

  • Talk with any case managers, doctors, pharmacists, or other persons that you say are important for your care needs

  • Help you find the services you need in your community

  • Write a care plan with you, your family's, and your PCP’s help

  • Stay in contact with you to check up on your health and keep track of your care plan and the progress you are making toward your care plan goals

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Long–Term Services and Support (LTSS)

The following is a list of Long–Term Care and Home and Community-Based Services for which you may be eligible:

  • Adaptive aids and medical equipment

  • Adult Foster Care

  • Assisted Living Services

  • Consumer Directed Services

  • Day Activity and Health Services

  • Dental Services

  • Emergency Response Services

  • Home Delivered Meals

  • Medical Supplies not available under the Texas Medicaid State Plan/1915(b) Waiver

  • Minor Home Modifications

  • Nursing services (in home)

  • Personal Assistance Services

  • In-Home or Out-of-Home Respite Services

  • Respite Care

  • Physical Therapy, Occupational Therapy, Speech Therapy

  • Transition Assistance Services

Not everyone qualifies for these services. You and your assigned Service Coordinator will complete a health risk assessment that helps to identify services that meet your health care needs. Some of these services may include those services in the list above. If you are eligible for these services and the service is medically necessary, you, your HealthSpring Service Coordinator, and your PCP will work together to get these services in place.

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Transportation

If you do not have a car or cannot get a ride for a medical visit, you can call the Medical Transportation Program for a ride at:
  • Tarrant County: 1-855-687-3255
  • Hidalgo County: 1-877-633-8747
This program is in place to help you get to a doctor’s visit for the care you need. This program is not for emergency transportation. If you have an emergency and cannot get a ride, call 911.

You should call for a ride as soon as you make your medical appointment. For routine medical care, you need to call at least two (2) working days or more before your visit. If you have a visit outside of the county you live in, you will need to call at least five (5) working days before your visit. The sooner you call the better. If you need help with setting up a ride, call Member Services. They will make the call for you.

The Medical Transportation Service Center is open to help you Monday through Friday from 8:00 a.m. until 5:00 p.m.

If the Medical Transportation Program is not available or cannot meet special needs you have, call HealthSpring Member Services or your HealthSpring Service Coordinator to help arrange transportation for you.

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Value-Added Services

With HealthSpring, you also get extra benefits like:

  • Enhanced transportation services*

  • Extra dental services  for adults and pregnant women*

  • Extra vision benefits *

  • Extra behavior benefits * - NEW! (effective 3/1/2013)

  • $10 calling card for those who receive their
    Texas Health Steps checkup within the first 90 days - NEW! (effective 3/1/2013)

  • Active&Fit program

  • Respite Care services

  • Fans of HealthSpring program

  • Toll Free 24 hour Nurse Advice Line

  • Over the counter medications, up to $10 monthly allowance

*For members not covered by Medicare. For detailed information about these services, click here, or to find out what benefits you can get, please call HealthSpring Member Services.

  • If you live in the Rio Grande Valley area, call 1-877-653-0327 (TTY 711)

  • If you live in the Fort Worth area, call 1-877-966-9272 (TTY 711)

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Health Care Benefits

  • Ambulance services

  • Audiology services (hearing tests) including hearing aids for adults (audiology services and hearing aids for children under the age of 21 are a non-capitated service)

  • Behavioral Health

    • Inpatient mental health services for adults and children

    • Outpatient mental health services for adults and children

    • Outpatient chemical dependency services for children (under age of 21)

    • Detoxification services

    • Psychiatry services

    • Counseling service for adults (21 years of age and over)

    • Assessment via Provider or self-referral

    • Substance use disorder treatment in residential and non-residential settings

    • Medication assisted therapy

  • Birthing services provided by a physician or Advanced Practice Nurse in a licensed birthing center

  • Birthing services provided by a licensed birthing center

  • Chiropractic services

  • Dialysis

  • Durable medical equipment and supplies

  • Emergency services

  • Family planning services

  • Home health care services

  • Hospital services, outpatient

  • Laboratory services

  • Mastectomy, breast reconstruction, and related follow-up procedures, including:

    • Outpatient services provided at an outpatient hospital and ambulatory health care center as clinically appropriate; and physician and professional services provided in an office, inpatient, or outpatient setting for:

      • All stages of reconstruction on the breast(s) on which medically necessary mastectomy procedure(s) have been performed;

      • Surgery and reconstruction on the other breast to produce symmetrical appearance;

      • Treatment of physical complications from the mastectomy and treatment of lymphedemas; and

      • Prophylactic mastectomy to prevent the development of breast cancer

      • External breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed

  • Medical checkups and Comprehensive Care Program (CCP) Services for children (under age 21) through the Texas Health Steps Program

  • Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps medical checkup for children 6 months through 35 months of age

  • Optometry, glasses, and contact lenses, if medically necessary

  • Podiatry

  • Prenatal care

  • Primary care provider services

  • Preventive services including an annual adult wellcheck for patients 21 years of age and over

  • Radiology, imaging, and x-rays

  • Specialty physician services

  • Therapies: physical, occupational, and speech

  • Transplantation of organs and tissues

  • Vision Care

If you have Medicare coverage in addition to STAR+PLUS, your Medicare coverage will be your primary coverage. This means that your Medicare coverage is always the first insurance to be used. STAR+PLUS will not change your Medicare coverage.

If you can receive Medicare and Medicaid, you are Dual-Eligible. If you have questions about your Medicare benefits and coverage, please visit www.medicare.gov.

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