Preventive Services

A one-time screening ultrasound for people at risk. The Plan only covers this screening if you get a referral for it as a result of your "Welcome to Medicare" physical exam.

For qualified individuals (generally, this means people at risk of losing bone mass or at risk of osteoporosis), the following 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.

For people 50 and older, the following are covered:

• Flexible sigmoidoscopy (or screening barium enema as an alternative) every 48 months.
• Fecal occult blood test, every 12 months.

For people at high risk of colorectal cancer, we cover:

• Screening colonoscopy (or screening barium enema as an alternative) every 24 months.

For people not at high risk of colorectal cancer, we cover:

• Screening colonoscopy every 10 years (120 months), but not within 48 months of a screening sigmoidoscopy.

For people who ask for an HIV screening test or who are at increased risk for HIV infection, we cover one screening exam every 12 months.

For women who are pregnant, we cover up to three screening exams during a pregnancy.

Covered Medicare Part B services include:

• Pneumonia vaccine.
• Flu shots, once a year in the fall or winter.
• Hepatitis B vaccine if you are at high or intermediate risk of getting Hepatitis B.
• Other vaccines if you are at risk and they meet Medicare Part B coverage rules.

We also cover some vaccines under our outpatient Part D prescription drug benefit.

Covered services include:

• One baseline exam mammogram between the ages of 35 and 39.
• One screening mammogram every 12 months for women age 40 and older.
• Clinical breast exams once every 24 months.

Covered services include:

• For all women: Pap tests and pelvic exams are covered once every 24 months.
• If you are at high risk of cervical cancer or have had an abnormal Pap test and are of childbearing age: one Pap test every 12 months.

For men age 50 and older, covered services include the following, once every 12 months:

• Digital rectal exam.
• Prostate-specific antigen (PSA) test.

Blood tests for the detection of cardiovascular disease (or abnormalities associated with an elevated risk of cardiovascular disease) once every 5 years (60 months).

The Plan covers a one-time "Welcome to Medicare" physical exam, which includes a review of your health, as well as education and counseling about the preventive services you need (including certain screenings and shots), and referrals for other care if needed.

Important: You must have the physical exam within the first 12 months you have Medicare Part B. When you make your appointment, let your doctor's office know you would like to schedule your "Welcome to Medicare" physical exam.

If you've had Part B for longer than 12 months, you can get an annual wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. This is covered once every 12 months.

Note: Your first annual wellness visit can't take place within 12 months of your "Welcome to Medicare" exam. However, you don't need to have had a "Welcome to Medicare" exam to be covered for annual wellness visits after you've had Part B for 12 months.

We cover this screening (includes fasting glucose tests) if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests may also be covered if you meet other requirements, like being overweight and having a family history of diabetes.

Based on the results of these tests, you may be eligible for up to two diabetes screenings every 12 months.

This benefit is for people with diabetes, renal (kidney) disease (but not on dialysis), or after a transplant when ordered by your doctor.

We cover 3 hours of one-on-one counseling services during your first year that you receive medical nutrition therapy services under Medicare (this includes our Plan, any other Medicare Advantage plan, or Original Medicare), and 2 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 another calendar year.

If you use tobacco, but do not have signs or symptoms of tobacco-related disease: we cover two counseling quit attempts within a 12-month period. Each counseling attempt includes up to four face-to-face visits.

If you use tobacco and have been diagnosed with a tobacco-related disease or are taking medicine that may be affected by tobacco: we cover cessation counseling services. We cover two counseling quit attempts within a 12-month period. Each counseling attempt includes up to four face-to-face visits, however, you will pay the applicable inpatient or outpatient cost sharing.