How Does Medicare Cover Osteoporosis?

Nobody wants to feel weaker, especially as we get older. Much of our stability and strength comes from our skeletal systems, but as we age, our bones can become brittle. One of the causes of this is osteoporosis, a condition that slowly weakens bones as the condition progresses. Around 54 million Americans live with osteoporosis or at an increased risk of developing it. If you’re one of these Americans, Medicare may be able to assist you by covering some of your diagnostic and treatment options.

Medicare and Osteoporosis Screenings

The first step to figuring out whether or not you have osteoporosis is to test for it. If you’re at a heightened risk of developing osteoporosis or showing symptoms, your doctor may take steps to monitor for signs of weakening bones. Your doctor may order x-rays to check the density of your bones if they suspect that you could be developing osteoporosis. If it’s ordered by a doctor and medically necessary, the x-ray will be covered under Medicare Part B. Once you’ve met your annual deductible, you’ll owe 20 percent of the Medicare-approved amount and a separate copay if you received your x-ray in a hospital outpatient setting.

If your doctor accepts Medicare assignment, you’ll owe nothing for these tests.

If these x-rays show signs of possible osteoporosis, other issues with your bones, or you’re a woman at elevated risk of osteoporosis, you should have a bone mass measurement test covered once every 24 months. It may be covered more often if your doctor orders them as medically necessary. You may also have this test covered if you already have osteoporosis and your doctor wants to monitor the effectiveness of a treatment. If your doctor accepts Medicare assignment, you’ll owe nothing for these tests. The test uses x-rays to measure the calcium and minerals within the bones and can diagnose osteoporosis.

Osteoporosis Treatment Options

The most common form of treatment for osteoporosis is through a prescription medication regimen that take a two-pronged approach. One set of drugs aim to stimulate the production of new bone tissue while the other slows down the absorption of older tissue. If your osteoporosis is related to menopause, you may also be prescribed estrogen.

In most cases, you’ll have your prescription drugs covered by a Medicare Part D or Medicare Advantage plan that includes drug coverage. In these cases, you’ll need to meet your deductible and then owe the prescription drug copay that’s designated by your plan. Each plan has different costs and cost tiers for different prescription drugs, so if you need a certain prescription, it may be worth exploring your Medicare insurance plan options with that in mind.

If you meet these criteria, you’ll owe between zero percent and 20 percent of the Medicare-approved amount of the drug after meeting your Part B deductible.

In specific cases, Medicare can cover your osteoporosis drugs under Medicare Part A and Part B. You must be female, eligible for Part B and home health services, have a bone fracture from postmenopausal osteoporosis, and get certified by your doctor that you and your caregivers are unable and unwilling to give yourself the injections. If you meet these criteria, you’ll owe between zero percent and 20 percent of the Medicare-approved amount of the drug after meeting your Part B deductible. The copay can change depending on the drug’s price. You also owe nothing for the home health nurse who is visiting to administer the drug.

Lifestyle Changes and Supplementation

While it may not cure or treat osteoporosis, you should take steps to make sure that you don’t injure yourself. Under the guidance of your doctor, you could try vitamin supplementation, though it’s important to remember that the effectiveness of supplements are a mixed bag. In terms of this article, it’s also unlikely that they’ll be covered by Medicare except in the rare circumstances that your doctor prescribes a supplement and your Medicare drug plan exception request or appeal is successful.

Chief among these lifestyle changes are quitting smoking and eating a bone-healthy diet rich in calcium.

You can also make certain healthy changes that can either improve bone health or slow the degeneration down. Chief among these lifestyle changes are quitting smoking and eating a bone-healthy diet rich in calcium. Exercise and moderating your alcohol consumption can also help. As an added bonus, Medicare can help you cover services that’ll aid you in quitting smoking and moderate your alcohol consumption, while some Medicare Advantage plans may offer memberships to gyms and fitness programs.

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Osteoporosis is a common but treatable condition. Since Medicare covers screenings, it’ll be easier to catch a developing case of osteoporosis earlier. With the broad coverage offered by Medicare of your treatment and prevention options, it means you don’t have to pick and choose your plan based on what’s affordable. Together, these make osteoporosis a condition where you still must be mindful but doesn’t have to be the roadblock to living that it may have been in the past.