Does Medicare cover osteoporosis treatment?
Osteoporosis, a medical condition characterized by weakened bones, affects almost 10 million Americans. Bone density naturally decreases as we age. This leaves older adults more at risk for developing osteoporosis and associated symptoms, like bone fractures. If you have osteoporosis, taking measures to improve your bone density can prevent them from breaking and help you stay healthy and active.
If you have osteoporosis, Medicare helps pay for screenings, injectable drugs, and physical therapy under certain conditions. Medicare Part D covers the most popular medications for osteoporosis, but it’s important to check with your plan to be sure your prescribed medications are covered by your plan.
Key takeaways:
Medicare covers osteoporosis screenings and medications under certain conditions. Medicare also covers physical therapy for osteoporosis.
Medicare Part D plans generally cover popular osteoporosis medications.
What is osteoporosis?
Regardless of age, our bones go through a continuous process of repair (often called bone remodeling). Old bone tissue breaks down, releasing minerals into the blood, then new bone tissue forms. When a person has osteoporosis, new bone tissue doesn’t form as quickly as old bone tissue breaks down, which leads to fragile bones that can fracture more easily.
People of all ages can experience osteoporosis, but your likelihood of developing the bone-weakening condition increases as you age. It’s most common in postmenopausal women and older men. Osteoporosis is considered to be a “silent” disease because you usually don’t feel any symptoms until you break a bone. Even minor bumps and falls can lead to fractures in people with osteoporosis, especially in the hip, spine, or wrist.
Aside from age, here are a few other factors that influence the development of osteoporosis:
Hormones: As mentioned above, postmenopausal women are most susceptible to osteoporosis. Hormonal changes, like a decline in estrogen levels, can cause osteoporosis.
Genetics: A family history of osteoporosis can increase your risk of developing osteoporosis.
Dietary factors: Calcium and vitamin D are both important for bone health, and deficiency can cause osteoporosis.
Lifestyle factors: Being physically inactive, smoking, excessive alcohol consumption, and long-term use of certain medications can contribute to osteoporosis.
Medical conditions: Rheumatoid arthritis, celiac disease, hormone disorders, and other medical conditions can increase your risk for developing osteoporosis.
How to manage osteoporosis
While you may not feel any symptoms with osteoporosis, fractures or broken bones are certainly a cause for concern if they occur due to the condition. There are a few preventative measures you can take to avoid a painful incident.
Prevention and management techniques include a diet with foods rich in calcium and vitamin D, regular weight-bearing exercise, healthy habits, physical therapy, and drug injections like Prolia. It’s important to consult with your doctor about what strategy is best for you and your health needs.
Does Medicare cover osteoporosis treatment?
Medicare covers screenings, injectable drugs, and physical therapy for osteoporosis treatment if you meet certain conditions, which we’ll outline below.
If you need prescription drugs to manage osteoporosis, your Medicare Part D plan will likely cover your prescriptions. The majority of Part D plans cover the most common medications used to treat osteoporosis.
Medicare coverage of osteoporosis screenings
Medicare covers testing for osteoporosis, which is often called a bone mass screening or bone density test. These tests measure bone density and calculate how at-risk you are to experience fractures.
Medicare will cover a bone density screening once every two years if you meet any of the following conditions:
You’re a woman with an estrogen-deficiency, and your doctor believes you are 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.
You’re being monitored to see if your current osteoporosis drug therapy is working.
Note: If deemed medically necessary, Medicare may cover more frequent osteoporosis screenings.
What osteoporosis medications are covered by Medicare?
There are a few different options for osteoporosis medications, including pills, IV infusions, and injectable drugs.
Medicare helps pay for the cost of an osteoporosis injectable drug as well as assistance from a home health nurse to inject the drug if:
You are a woman.
You have a fracture that’s related to postmenopausal osteoporosis.
Your doctor determines that you and your caregivers are unable to learn how to inject the drug.
You are eligible for Medicare Part B and meet the requirements for Medicare home health services.
If you only need medication or can administer the injections yourself, you’ll likely get the coverage from a Part D prescription drug plan. Most prescription drug plans cover the most popular medications for osteoporosis, but it’s always a good idea to review the drugs covered by your specific drug plan.
If you choose an IV infusion option to treat osteoporosis, you’ll need to check with your plan to see which health facilities and providers are covered by your plan.
Does Medicare cover physical therapy for osteoporosis?
Medicare covers the cost of physical therapy for osteoporosis if you’ve recently broken a bone or if you have chronic pain or mobility issues due to osteoporosis. The number of physical therapy sessions that are covered and the out-of-pocket costs you'll owe vary based on your specific Medicare coverage.
Generally, Original Medicare covers outpatient physical therapy services and Medicare Supplement (also called Medigap) helps pay for out-of-pocket expenses related to physical therapy.
Because Medicare Advantage plans cover the same services as Original Medicare, your physical therapy sessions will be covered whether you have Original Medicare or Medicare Advantage. However, coverage levels and pricing structures vary by plan. We recommend checking with your insurance to see how much you’ll have to pay for physical therapy.
If you're not sure what Medicare covers or what you’ll owe for a specific service, we’re here to help! Schedule a free consultation or call us at (855) 900-2427 to get help understanding your Medicare coverage. We can also help you find a better plan for your needs if you’re eligible for a switch.