18 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Medical Benefits Chart Services that are covered for you What you must pay when you get these services permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices. • Leg, arm, back, and neck braces; trusses; and artificial legs, arms, and eyes including adjustments, repairs, and replacements required because of breakage, wear, loss, or a change in the patient's physical condition. • Physical therapy, speech therapy, and occupational therapy. Medical nutrition therapy This benefit is for people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when ordered by your doctor. We cover three hours of one-on-one counseling services There is no coinsurance, copayment, or during your first year that you receive medical nutrition deductible for members eligible for therapy services under Medicare (this includes our plan, any Medicare-covered medical nutrition other Medicare Advantage plan, or Original Medicare), and therapy services. two hours each year after that. If your condition, treatment, or diagnosis changes, you may be able to receive more hours of treatment with a physician's order. A physician must prescribe these services and renew their order yearly if your treatment is needed into the next calendar year. Medicare Diabetes Prevention Program (MDPP) MDPP services will be covered for eligible Medicare beneficiaries under all Medicare health plans. There is no coinsurance, copayment, or MDPP is a structured health behavior change intervention deductible for the MDPP benefit. that provides practical training in long-term dietary change, increased physical activity, and problem-solving strategies for overcoming challenges to sustaining weight loss and a healthy lifestyle. Medicare Part B prescription drugs† These drugs are covered under Part B of Original Medicare. Your applicable prescription drug Members of our plan receive coverage for these drugs copayment or coinsurance through our plan. Covered drugs include: • Insulin furnished through an item of durable medical equipment (such as a medically necessary insulin pump). † Your provider must obtain prior authorization from our plan. * Your cost-sharing for these services or items doesn't apply toward the maximum out-of-pocket amount. kp.org