Medicare Coverage for Osteoporosis: What You Need to Know

If you've been diagnosed with osteoporosis or are at risk for bone loss, you need to know exactly what Medicare covers. The short answer is yes: Medicare covers bone mass measurements (bone density tests) and many osteoporosis treatments, but how those services are paid for depends on whether you've chosen Traditional Medicare or a Medicare Advantage plan.

Medicare Part B covers bone mass measurements once every 24 months (or more often if medically necessary) at no cost to you, provided your doctor accepts assignment and you meet certain risk criteria. These criteria include being a woman whose doctor determines she is estrogen-deficient and at clinical risk for osteoporosis, having vertebral abnormalities, receiving steroid treatments, or having primary hyperparathyroidism.

When it comes to treatment, the path you choose matters. The real choice isn't between a supplement and Advantage - it's between Traditional Medicare (Parts A and B) and Medicare Advantage (Part C).

If you stay on Traditional Medicare, Part B covers injectable osteoporosis drugs for women who meet specific criteria, including being eligible for Medicare based on age, having a bone fracture related to postmenopausal osteoporosis, and being unable to learn to give themselves the injection. In this scenario, you'll pay 20% of the Medicare-approved amount for the drug, and the Part B deductible applies. A Medicare Supplement (Medigap) plan can help cover that 20% coinsurance. Remember, a supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, designed to fill the gaps by law.

For daily oral medications or other treatments not covered by Part B, you'll need a standalone Medicare Part D prescription drug plan. Part D plans have their own formularies, so you'll want to verify that your specific osteoporosis medication is covered and check the tier it falls under to understand your out-of-pocket costs.

If you choose a Medicare Advantage plan, your plan must cover everything that Traditional Medicare covers, including bone density tests and Part B injectable drugs. However, your costs, copays, and network restrictions will vary by plan. Most Medicare Advantage plans also include Part D prescription drug coverage, so your oral osteoporosis medications would be covered under the plan's formulary.

Managing osteoporosis is a long-term commitment, and having the right coverage ensures you can access the screenings and treatments you need. We're on your side of the table to help you understand your options and make the choice that protects what you've earned.