Superior Health Plan is a private insurance company that contracts with Medicaid, not Medicaid itself
Superior Health Plan (also called Superior) is a managed care organization — a private insurance company that has a contract with your state's Medicaid program to deliver coverage to Medicaid members. When you enroll in Superior through Medicaid, Superior becomes your health plan, but Medicaid is still the program paying for your care. You do not pay Superior directly; Medicaid pays Superior a monthly fee to cover you.
Superior operates in Texas, Florida, and Puerto Rico. In Texas, it is one of several managed care plans available to people on Medicaid. Your state Medicaid program decides which plans operate in your area and which groups of people (children, pregnant women, elderly adults, people with disabilities) can choose them. Superior does not decide who can join — your state does.
The key difference between Superior and traditional Medicaid is how your care is organized. With traditional Medicaid, you can usually see any doctor who accepts Medicaid. With Superior, you choose a primary care doctor from Superior's network, and that doctor coordinates your care. You typically need a referral from your primary care doctor to see a specialist.
Key Takeaways
- Superior Health Plan is a managed care company contracted by Medicaid, not a separate program — Medicaid still pays for your coverage.
- Superior operates only in Texas, Florida, and Puerto Rico, and your state decides whether you can choose it.
- Superior requires you to pick a primary care doctor and get referrals for specialists, whereas traditional Medicaid usually does not.
- Superior covers the same services as Medicaid in your state, but the network of doctors and hospitals may be different.
- You cannot switch between Superior and traditional Medicaid whenever you want — your state has open enrollment periods or specific times when you can change plans.
How Superior's network affects which doctors you can see
Superior maintains its own network of doctors, hospitals, and specialists. When you enroll in Superior, you are choosing to use that network. If your current doctor is not in Superior's network, you may have to switch doctors or pay out of pocket to see them (though emergency care is always covered).
Before you enroll in Superior, you can ask Superior or your state Medicaid office for a list of doctors and hospitals in the network near you. Check whether your current doctor, your child's pediatrician, or any specialist you see regularly is included. If the doctors you want to see are not in the network, you may want to stay on traditional Medicaid or choose a different managed care plan.
Superior's network varies by region within each state. A doctor may be in the network in one county but not another. Call Superior directly or check their website to confirm whether a specific provider is in your area's network before you enroll.
What Superior covers and what traditional Medicaid covers
Superior must cover all the same services that your state's Medicaid program covers. If your state Medicaid covers dental care, vision care, mental health services, and prescription drugs, Superior must cover them too. The benefit package does not change because you choose Superior instead of traditional Medicaid.
The difference is not what is covered but how you access it. With Superior, you go through your primary care doctor first. With traditional Medicaid, you can often call a specialist directly. Some people find the primary care doctor system helpful because it coordinates their care; others find it frustrating because it adds a step.
Superior may also offer extra benefits that traditional Medicaid does not — for example, fitness programs, transportation to appointments, or over-the-counter health items. These vary by plan and by state. Ask Superior what extra benefits they offer in your area.
How to learn about Superior is available to you
Superior is available only in Texas, Florida, and Puerto Rico. If you live in another state, Superior is not an option. If you live in one of those states, contact your state Medicaid office to find out whether Superior is available in your county and whether you are in a group that can choose it.
Your state Medicaid office can tell you which managed care plans are available to you based on your age, disability status, and whether you are pregnant. Some plans are only for children; some are only for adults over 65; some are for people with certain disabilities. You cannot choose Superior if your state has not made it available to your group.
Your state Medicaid office also sets the times when you can enroll in or switch between plans. This is usually during an open enrollment period once a year, though you may be able to change plans if you have a may have access to life event (moving to a new county, losing other insurance, having a baby).
When you might choose Superior over traditional Medicaid
Some people prefer managed care plans like Superior because they like having a primary care doctor who knows their medical history and coordinates all their care. If you see many different doctors, having one person manage your referrals can reduce confusion and make sure your doctors are talking to each other.
Superior's extra benefits may also matter to you. If Superior offers free transportation to medical appointments and traditional Medicaid does not, that could make a real difference in whether you can get to your appointments. Ask what extra benefits each plan offers in your area.
If you are happy with your current doctor and that doctor is in Superior's network, and Superior offers benefits you want, it can be a good choice. But if your doctor is not in the network or you prefer not to have a primary care doctor requirement, traditional Medicaid may work better for you.
When you might stay on traditional Medicaid instead
If your current doctor is not in Superior's network and you do not want to switch, stay on traditional Medicaid. Switching doctors can be disruptive, especially if you have a long-standing relationship with your provider or a complex medical condition.
If you see many specialists and do not want to get a referral from a primary care doctor each time, traditional Medicaid gives you more direct access. You can call a specialist and make an appointment without going through another doctor first.
If you travel frequently or live in multiple places, traditional Medicaid may be simpler because it is accepted by any Medicaid provider in the state, whereas Superior's network is specific to Superior. Check your state's rules — some states allow you to use out-of-network providers in traditional Medicaid; others do not.
How to enroll in Superior or switch plans
Contact your state Medicaid office to find out when you can enroll in or change plans. In most states, you can change plans during an annual open enrollment period, which is usually a few weeks in the fall or winter. Outside of open enrollment, you can change plans only if you have a may have access to life event.
To enroll, you will need to contact Superior directly or go through your state Medicaid office, depending on how your state handles enrollment. Your state Medicaid office can tell you the process. You will choose a primary care doctor from Superior's network as part of enrollment.
If you are already on Superior and want to switch to traditional Medicaid or a different managed care plan, wait for the next open enrollment period unless you have a may have access to event. Switching outside of open enrollment is usually not allowed.
Frequently Asked Questions
Is Superior Health Plan the same as Medicaid?
No. Superior is a private insurance company that Medicaid contracts with to deliver coverage. Medicaid is the government program that pays for your care. When you enroll in Superior, you are still on Medicaid — Superior is just the company managing your benefits.
Do I have to pay Superior directly?
No. Medicaid pays Superior directly. You do not pay a monthly premium or bill to Superior. You may have small copays when you use services, depending on your state's rules, but you do not pay Superior for coverage.
Can I see any doctor I want on Superior?
Only doctors in Superior's network. If your doctor is not in the network, you would need to switch doctors or pay out of pocket. Emergency care is always covered regardless of network status. Check Superior's provider list before you enroll to make sure your doctor is included.
What happens if I move to a state where Superior does not operate?
You would lose Superior coverage and would need to enroll in your new state's Medicaid program. This is considered a may have access to life event, so you can change plans outside of the normal open enrollment period. Contact your new state's Medicaid office right away.
Can I switch from Superior back to traditional Medicaid?
Yes, but usually only during open enrollment or if you have a may have access to life event. Contact your state Medicaid office to find out when you can make the change. If you are unhappy with Superior, ask your state what other plans are available to you.