HEALTHfirst benefits

We want to make sure you get the covered services you need

Look at this information carefully. It will help you understand what is covered by your plan, and how you can find the right care when you need it.

Some services need prior approval before you can get them. If you don't know if something needs approval, check with your doctor or call Member Services at 1-888-672-2277.

Some services need a prior authorization. Prior authorization is an approval that Aetna Better Health of Texas requires for certain services and medications. Some services need approval before they are given. The provider who is treating your child should get this approval. You can ask your doctor or us if an approval is needed for a service or treatment.

For Prior authorizations: Allow at least 3 business days for a response if medically appropriate. Urgent requests for medically non-urgent services will be handled within the timeframes for a routine request.

Here are some of the services available to you and your family:

  • Necessary medical care for adults and children
  • Vaccines to prevent illness (immunizations)
  • Chiropractic services
  • Podiatry services (foot care)
  • Laboratory and x-ray services
  • Surgery as an outpatient (no hospital stay)
  • Hospital care and outpatient care
  • Maternity care and newborn care
  • 24-hour nurse help line
  • 24-hour emergency care from an emergency room
  • Eye doctor services (includes eyeglasses and contact lenses, if medically necessary)
  • Hearing services and hearing aids
  • Home health agency services
  • Ambulance (for emergencies only)
  • Dialysis for kidney problems
  • Major organ transplants
  • Texas Health Steps medical and dental checkups
  • Physical exam for adults, once per year
  • Physical, occupational and speech therapy
  • Family planning services and supplies
  • HIV and sexually transmitted disease treatment
  • Behavioral health services (such as counseling and treatment)
  • Assistance with alcohol or drug abuse
  • Diabetic supplies
  • Health education classes
  • Rides to medical appointments through the Medical Transportation Program

Medicaid pays for most medications your primary care provider (PCP) or other doctor says you need. Your doctor will write a prescription for you to take to the drug store. The doctor may also be able to send the prescription directly to the drug store.

You can find a network pharmacy close to where you live.

If you need a ride to your doctor’s office, the Medical Transportation Program (MTP) can help. Call MTP as soon as you know your appointment date. Please call MTP to schedule a ride at least two work days before your appointment. If you need to cancel a ride, call MTP at least one work day before your appointment.  MTP can also help with money for gas for someone who drives you to an appointment. These drivers can be your family members, neighbors or other volunteers.

To learn more about MTP, or to make a reservation, call 1-855-687-3255 Monday through Friday, from 8 a.m. until 5 p.m.