Osteoporosis causes brittle, porous bones. Typically, Original Medicare (Part A and Part B) covers most outpatient screenings, treatments, and inpatient surgical procedures for osteoporosis.
A person enrolled in a Medicare Advantage (Part C) plan instead of Original Medicare should have equivalent coverage.
Medicare typically covers osteoporosis treatments when a Medicare-approved doctor orders them. For example, Part B covers physical therapy, while Part A covers surgical procedures.
What osteoporosis medications are covered by Medicare?
Medicare Part B covers injectable medications such as Prolia, as well as visits from a home health nurse to administer the injections, for women who have osteoporosis, qualify for Medicare home health services, and have a related fracture.
If a person receives these treatments in a hospital setting, Part A will cover them instead.
Medications that people can take themselves fall under Medicare Part D or Part C plans that include prescription drug coverage.
Does Medicare cover osteoporosis screenings?
Under Part B, Medicare provides coverage for various methods of measuring bone density as part of screening for osteoporosis. Part B will cover one test every 2 years in the following cases:
- if a woman has a diagnosis of low estrogen and a high risk of osteoporosis
- if a person has X-ray evidence of osteoporosis, low bone mass, or a vertebral fracture
- if a person needs these tests to evaluate the effectiveness of an osteoporosis medication
In 2025, once a person meets the $257 Part B deductible, Medicare will cover 80% of the cost for approved treatments, leaving the person responsible for the remaining 20%. Depending on income, a person must also pay a monthly premium of $185 or more.
For Part A, most people do not pay a premium but must meet a deductible of $1,676. Once a person has reached the deductible, Part A will cover hospital stays and necessary procedures, as well as postsurgery rehabilitation. Additional costs will accrue daily if a person’s hospitalization extends beyond 60 days.
Part D and Part C plans come from private insurance companies, and their premiums and deductibles vary. At Medicare.gov, people can explore the options available in their area.
For Part D coverage, a person’s out-of-pocket costs will depend on the medication’s tier (level) in the plan’s formulary (a list of covered drugs).
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.