Does Medicare Cover Bone Density Tests?
Bone density naturally decreases with age, leaving older adults more at risk for conditions like osteoporosis and bone fractures.
Medicare Part B covers bone density testing (also called a bone density scan) if you meet certain requirements. Medicare Advantage (Part C) also covers bone density testing, though you’ll need to make sure your provider is in network and that you don’t need prior authorization to receive coverage.
If you think you may be at risk for osteoporosis or bone fractures, reach out to your provider to discuss the details. Depending on their assessment, Medicare could cover your bone density testing.
Read on to learn more about bone density tests and Medicare’s coverage of this type of preventive screening.
Key takeaways
Medicare Part B covers bone density testing for eligible beneficiaries.
Eligibility requirements include estrogen deficiency (in women), signs of osteoporosis, osteopenia, vertebral fractures, and medication history.
If you meet the requirements, Medicare will cover the entire cost of your bone density test once every two years.
What is a bone density test?
A bone density test, also referred to as a bone density scan, a DEXA or DXA scan, is a low-dose x-ray that measures bone density. The scan measures calcium and other minerals in your bones to determine bone strength and thickness.
Who needs bone density testing?
Your provider may recommend bone density testing if they suspect you have osteopenia (low bone mass) or osteoporosis, or if you’re at risk of one of these conditions or fractures..
Additional factors for which your provider may recommend a bone density test include:
Gender and age: Most women over the age of 65 should have a bone density scan because they are at high risk of low bone density and fractures.
Body weight: Men and women with a very low body weight are at higher risk of fractures.
Height loss: If you’ve lost half an inch or more of height within one year.
Family history: If you have a family history of osteoporosis, your provider may recommend a bone density scan.
Medical conditions: If you have diabetes or rheumatoid arthritis.
Substance use: If you have used tobacco or alcohol over a long period of time.
Nutritional deficiencies: If you don’t get enough calcium or Vitamin D in your diet.
Does Medicare cover bone density tests?
Yes, Medicare will cover a bone density test once every two years if you meet certain conditions, including:
You’re a woman with an estrogen-deficiency and your doctor believes you’re at risk for osteoporosis
You have signs of possible osteoporosis from X-rays
You’re taking prednisone or other steroid-type drugs
You have primary hyperparathyroidism.
Your provider wants to monitor whether your current osteoporosis drug therapy is working
More frequent bone density tests may also be covered by Medicare if your provider deems them medically necessary.
Comparing bone density test coverage across Medicare plans
Below, we dive into the differences and similarities of bone density testing coverage depending on your specific Medicare plan.
Original Medicare (Parts A and B) coverage
Medicare Part B covers bone density scans if you meet the conditions listed above. This test is covered as a preventive service. If your healthcare provider accepts assignment, you pay nothing for the scan.
If your provider deems it medically necessary, you may qualify for more frequent coverage of bone density testing through Medicare Part B.
Medicare Advantage (Part C) coverage
Medicare Advantage (Part C) covers the same services and equipment as Original Medicare (Parts A & B), which means it also covers bone density testing if you meet the requirements.
However, each Medicare Advantage plan has its own networks, benefits, and requirements for testing. For example, if you have a Medicare Advantage plan and receive your bone density scan out-of-network, you may have to pay the full price of the scan out-of-pocket.
Original Medicare vs. Medicare Advantage for preventive care
There are many factors to consider when deciding between Original Medicare or a Medicare Advantage plan. Choosing the right plan for your unique circumstances is important as neither coverage is one-size-fits-all.
At Chapter, we make it easy for you to find the best Medicare plan for your specific health and budget. We’ll answer any questions you have, explain your options, help you compare or switch plans, and ensure that you’re getting the best value from your coverage.
Schedule a free consultation or call us at (855) 900-2427 to get your questions answered and feel confident in your Medicare decisions.
Bottom line
If you’re at risk for osteoporosis or broken bones, your provider may recommend bone density testing. This test, also called a DEXA or DXA scan, is covered by Medicare Part B and Part C (Medicare Advantage) if you meet certain criteria. These criteria include estrogen-deficiency (in women), signs of osteoporosis or osteopenia, and whether or not you’re taking prednisone or other steroid drugs.
If you meet the requirements, Medicare will cover the full cost of the scan every 24 months.
Sources
Bone density scan. (n.d.). https://medlineplus.gov/lab-tests/bone-density-scan/
Bone mass measurements. (n.d.). Medicare. https://www.medicare.gov/coverage/bone-mass-measurements