Picking a Health Plan and a Doctor

When you are in the STAR program you have to pick a health plan.  It is important for you to make the right choices in selecting your health plan. The best thing to do is ask questions: what services are available, what doctors, clinics, and hospitals can you use? Knowing the right questions to ask will help you find the health plan that best fits your needs.

This list of questions may help you decide which health plan to pick.  These questions are only sample questions. You may have some of your own questions to ask your doctor, but this is a good place to start.  Every health plan in Texas has to give you the answers to the questions listed here. 

Ask These Questions For Each Health Plan Available To You

• Are the doctors I want to use part of the health plan’s network?
• What preventive services are covered?
• What extra (value-added) services will I receive?
• How does the health plan handle after-hours care or emergencies? Where would I go for care? Who provides it?
• If I need a hospital, which hospitals can I use?
• If I have a problem with the health plan, what is the health plan’s complaint process?
• How do I change my primary care provider (PCP)?
• Can I use a specialist as my PCP? How do I do this?
• Is the information provided by the health plan available in a way that I can use it?  For example, Braille, audiocassette or other formats.
• Will the provider get an interpreter if sign language is the only way for me to communicate?  How do I arrange for an interpreter?
• Will the provider arrange for an interpreter if I speak another language other than English?

You may also want to ask your doctor some questions:

• Can the doctor or clinic that I currently use continue to care for me under the STAR Medicaid managed care health plan I am considering?
• What are the provider’s office hours?  Are they open in the evenings or weekends?
• How far in advance must regular appointments be scheduled?
• Is the office close to a bus stop? Is the office convenient to my home or work?
• Can I get into the office if I have a disability? Does the office have elevators, ramps, and room for wheelchairs?
• Are the examining tables and other equipment in the office accessible (adapted for people with disabilities)?

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