Medicare Coverage for Osteoporosis

Medicare covers a bone mass screening test, or bone density test, once every 24 months — or more often if medically necessary — when you meet certain criteria.

Bone density tests establish a formal diagnosis of osteoporosis. They can also assess the efficiency of osteoporosis drug therapy by identifying your bone mass and quality.

Qualifying Medicare beneficiaries pay nothing for bone mass tests.

There are several different procedures your doctor may use to test your bone density.

While these preventative services are free for Medicare beneficiaries who qualify, research shows that bone mass tests are often underutilized.

According to a 2019 report commissioned by the National Osteoporosis Foundation, 2 million Medicare recipients suffered fractures in 2015.

But only 9% of those beneficiaries had been screened for osteoporosis within six months of sustaining their fracture.

Many medications available today can slow the rate of bone loss and, in some cases, even rebuild bone strength.

Osteoporosis medications include oral drugs such as tablets and liquids. You may also be prescribed injectable drugs that you receive at your doctor’s office or administer to yourself at home.

According to the Mayo Clinic, the most widely prescribed osteoporosis medications for both men and women are bisphosphonates.

Medicare Part D plans and Medicare Advantage plans with prescription drug coverage will cover a portion of the cost of most bisphosphonates. Popular osteoporosis drug Tymlos is also covered under most Part D plans.

How much you pay out-of-pocket for your prescription depends on your plan’s formulary, or the list of drugs covered by your plan either in part or in full. Brand-name drugs and specialty drugs will cost more than generic drugs.

The amount you pay for injectable drugs or intravenous infusions given by a health care professional in a medical office or hospital setting is different than what you might pay for a prescription you pick up at the pharmacy.

Medicare Part A or Medicare Part B will pay for a portion of the cost of osteoporosis medications delivered intravenously or by injection. These medications may include ibandronate (Boniva), zoledronic acid (Reclast), denosumab (Prolia) and sometimes calcitonin (Miacalcin).

You will owe a 20% coinsurance payment for the Medicare-approved cost of injectable drugs, and the Part B deductible applies.

You will owe nothing for the home health nurse who visits to inject the drug if you meet the above conditions.

If you have Medicare and limited income and resources, the Social Security Administration may be able to help you cover the cost of your Medicare prescription drug plan through their Extra Help program.

To see if you qualify, call the Social Security Administration at 1-800-772-1213 or visit the Social Security Administration’s website to learn more and fill out an application.

Osteoporosis is a disease that causes bones to become weak and brittle.

As bones weaken and become less dense, they are more likely to fracture.

Osteoporosis-related fractures most often occur in the hip, wrist or spine.

Generally, there are few if any symptoms of osteoporosis at first.

Several factors — including your sex, age, race, lifestyle choices and medical conditions — can increase your likelihood of developing osteoporosis.

For example, women are much more likely than men to develop osteoporosis, especially after menopause.

There is no cure for osteoporosis. Treatment is often based on how likely you are to break a bone in the next 10 years. Your risk factor is determined using such information as the results of a bone density test.

If you aren’t at high risk of a bone fracture, you may not need medication. Instead, your treatment may focus on reducing risk factors through lifestyle changes.