2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 80 Services that are covered for you What you must pay when you get these services in-network and out-of-network There is no coinsurance, Bone mass measurement copayment, or deductible for For qualified individuals (generally, this means people at risk Medicare-covered bone mass of losing bone mass or at risk of osteoporosis), the following measurement. services are covered every 24 months or more frequently if medically necessary: procedures to identify bone mass, detect bone loss, or determine bone quality, including a physician’s interpretation of the results. There is no coinsurance, Breast cancer screening (mammograms) copayment, or deductible for Covered services include: covered screening · One baseline mammogram between the ages of 35 and mammograms. 39 · One screening mammogram every 12 months for women age 40 and older · Clinical breast exams once every 24 months Cardiac rehabilitation services $0 copayment for each Comprehensive programs of cardiac rehabilitation services Medicare-covered cardiac rehabilitative visit.†† that include exercise, education, and counseling are covered for members who meet certain conditions with a doctor’s order. Intensive cardiac rehabilitation services $0 copayment for each The plan covers intensive cardiac rehabilitation programs Medicare-covered intensive cardiac rehabilitative visit.†† that are typically more rigorous or more intense than cardiac rehabilitation programs.