Medicaid Medical Coverage | UPMC for You
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Medical Coverage

UPMC for You covers services that are medically necessary. Some of the services may have limits, copayments, or need a referral from your PCP or require prior authorization by UPMC for You. For more information, please see the UPMC for You Member Handbook or contact the Health Care Concierge team. Help is available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 8 a.m. to 8 p.m. TTY users should call 711.

Members choose a primary care provider (PCP). A PCP is a personal doctor or Certified Registered Nurse Practitioner (CRNP). He or she provides or arranges all of our members' health care needs.

If a member needs to see a specialist, our doctors help take care of the details. There is no paperwork to worry about.

Services that do not require a referral:

  • Well-woman visit
  • Pregnancy/birth services
  • Family planning
  • Vision exams
  • Substance abuse treatment
  • Dental care
  • Behavioral health

A PCP can be a family and general practice doctor, a pediatrician, an internal medicine doctor, or a CRNP. Family and general practice doctors treat all family members. Most pediatricians treat children, and most internal medicine doctors treat adults. A CRNP is a registered nurse with advanced training in a specialty area, certified by the boards in that specialty area. A CRNP may diagnose a condition or prescribe medicine under the direction of a doctor.

The Find A Doctor search tool can help our members find and select a doctor that is conveniently located.

View the UPMC for You Member Handbook for more information about covered benefits.

Your managed care plan may not cover all your health care expenses. Read your member handbook carefully to determine which health care services are covered.