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Medical Coverage

UPMC Community HealthChoices covers all medical services that are covered by the Pennsylvania Department of Human Services’ Medicaid Adult Benefit Package. Many services can be accessed through network providers without a referral. These include:

  • Annual and preventive ob-gyn services
  • Pregnancy/Birth services
  • Family planning
  • Routine vision exams
  • PCP services
  • Routine dental care
  • Behavioral health services (covered by Behavioral Health MCOs)

Participants who are dual eligible for Medicare and Medicaid must use their Medicare medical benefits before using UPMC Community HealthChoices benefits. When using Medicare benefits, medical providers must be in the participant’s Medicare network. When using UPMC Community HealthChoices benefits, medical providers must be in the UPMC Community HealthChoices network.

Find participating UPMC Community HealthChoices medical providers.

Participants who need help finding a medical provider, or have questions about their medical benefits, can call the UPMC Community HealthChoices HealthCare Concierge team at 1-844-833-0523 (TTY: 711).

For more information on medical services, view the UPMC Community HealthChoices handbook.

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