Utah Medicaid & PCN Guidelines

Utah Medicaid programs offer health insurance to individuals who meet specific requirements. The Utah Department of Health has a health plan through the Primary Care Network (PCN) where primary care physicians provide medical services.

Qualifications

• To qualify for PCN, an applicant must be between the ages of 19 and 64, be a U.S. citizen or legal resident, not have medical coverage and be ineligible for Medicaid. The maximum income allowed for one person is $1,354 a month. For each additional member of the household, add $467 a month.

Eligibility

• An applicant must re-apply every 12 months. The annual enrollment fee is due when the application is accepted.

Services

• Primary care services include both medical and dental care. Medical care includes doctor visits, prescriptions, immunizations, labs, x-rays, birth control, eye exams and in some cases emergency room visits. Dental coverage is for cleanings, x-rays and fillings.

Items Not Covered

• A member will not have coverage for specialty tests, hospital stays and care from specialists.

Cost

• The yearly premium is $15, $25 or $50 and depends on the applicant’s income. The maximum out-of-pocket amount a member must pay annually for co-pays is $1,000.