Medicare Osteoporosis Coverage Options
- Osteoporosis is a bone condition that can often be managed with testing and medications. Find out more about how Medicare pays for osteoporosis treatment.
Osteoporosis — sometimes referred to as "the silent disease" — is a condition in which the bones become weak and brittle. Osteoporosis has many causes, including the natural aging process, genetic factors and menopause.
While osteoporosis can develop at any age, the condition tends to be more common in older adults. Bone density tests to help detect bone loss are generally recommended for women aged 65 and older and men aged 70 and older.
Medicare osteoporosis coverage may help cover some costs for testing and treatment.
What Types of Bone Density Tests Does Medicare Osteoporosis Coverage Include?
Medicare covers bone density tests that measure bone mass and bone loss and aid in diagnosing osteoporosis. To qualify for coverage of bone density screening tests, Medicare recipients are generally required to meet at least one of the following criteria:
- Be a female at risk for developing osteoporosis (as determined by a medical professional)
- Have a previous diagnosis of osteoporosis (follow-up tests for additional bone loss and to measure treatment progress)
- Have a previous diagnosis of hyperparathyroidism (a hormonal condition that can cause bone loss)
- Have previous X-rays that indicate osteoporosis or vertebral fractures
- Be currently taking or planning to take steroid medications such as prednisone
There are several types of bone density tests that a physician may order when osteoporosis is suspected or to monitor individuals diagnosed with osteoporosis. These tests include:
- Single energy X-ray absorptiometry (SEXA): This test measures bones and bone loss in the forearms
- Bone sonometry (ultrasound): This test utilizes soundwaves to measure linear acoustic bone parameters
- Quantitative computed tomography (QCT): This test measures bone mineral density
- Dual energy X-ray absorptiometry (DXA): This test utilizes ionizing radiation to measure bones and bone loss in the lumbar spine and hips
Is Reclast Covered by Medicare Part B?
Medicare Part B may help cover the costs of Reclast for Medicare recipients who meet certain criteria. The medication must be determined a medically-necessary therapy, and it must be administered by a physician or other health professional in an outpatient setting.
Medicare Part A may also cover Reclast injections that are administered in hospitals or skilled nursing facility settings. Since Reclast is an injectable drug that's typically administered by a health professional, in most cases, it does not qualify for prescription drug coverage under Medicare Part D.
Which Oral Osteoporosis Medications Are Covered Under Medicare Part D?
Both Medicare Part D and certain Medicare Advantage plans may cover bisphosphonate medications in tablet and liquid form for the treatment of osteoporosis. These medications include Actonel, Boniva and Fosomax, and they're typically taken at daily, weekly or monthly intervals.
How Often Are Bone Density Tests Covered by Medicare?
Medicare typically covers bone density tests once every 24 months. In some cases, physicians may order bone density tests more frequently, and Medicare may cover the additional tests if they're considered medically necessary. Factors that may increase the frequency of bone density tests include a high risk of fracture in certain individuals, a current diagnosis of osteoporosis and the use of cortisone-like medications.