Medicare Coverage for Osteoporosis: Bone Density Testing, Medications, and Fracture Care

Osteoporosis -- a condition of low bone density that increases fracture risk -- affects more than 10 million Americans, the majority of whom are Medicare beneficiaries. Hip fractures in particular carry serious consequences for older adults, with significant mortality and loss of independence. Medicare covers a range of osteoporosis prevention and treatment services.

Medicare covers bone density measurement (dual-energy X-ray absorptiometry, or DEXA scan) at no cost for qualifying beneficiaries:

Who qualifies for free bone density testing:

• Women who have been determined by their doctor to be estrogen-deficient and at clinical risk for osteoporosis
• Individuals with vertebral abnormalities
• Individuals receiving or expected to receive glucocorticoid (steroid) therapy for more than 3 months
• Individuals with primary hyperparathyroidism
• Individuals being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy

Frequency: Every 24 months (more frequently if medically necessary).

Note: The U.S. Preventive Services Task Force recommends bone density screening for all women 65 and older -- Medicare covers this screening at no cost.

Oral bisphosphonates (first-line therapy):

• Alendronate (Fosamax) -- generic available, very low cost
• Risedronate (Actonel, Atelvia) -- generic available
• Ibandronate (Boniva) -- generic available

IV bisphosphonates (Part B when administered in office):

• Zoledronic acid (Reclast) -- annual IV infusion; covered under Part B at 20% coinsurance when administered in a clinical setting

RANK ligand inhibitor:

• Denosumab (Prolia) -- subcutaneous injection every 6 months; covered under Part B when administered by a healthcare provider

Anabolic agents (for severe osteoporosis):

• Teriparatide (Forteo) -- daily self-injection; covered under Part D (specialty tier)
• Abaloparatide (Tymlos) -- daily self-injection; covered under Part D (specialty tier)
• Romosozumab (Evenity) -- monthly injection; covered under Part B when administered in office

Selective estrogen receptor modulator:

• Raloxifene (Evista) -- generic available; covered under Part D

Several osteoporosis medications are covered under Part B (not Part D) when administered by a healthcare provider in a clinical setting:

• Zoledronic acid (Reclast) infusion
• Denosumab (Prolia) injection
• Romosozumab (Evenity) injection

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

For women with osteoporosis who have had a bone fracture related to post-menopausal osteoporosis and are unable to self-inject, Medicare Part B covers:

• Injectable osteoporosis drugs
• A home health nurse to administer the injection

Hip fracture surgery (Part A): Covered under Part A for inpatient hospitalization. Hip fracture repair (ORIF or hip replacement) is one of the most common surgeries in Medicare.

Vertebral fracture treatment (Part B): Vertebroplasty and kyphoplasty (procedures to stabilize compression fractures) are covered under Part B.

Post-fracture rehabilitation: Physical therapy, occupational therapy, and skilled nursing facility care are covered under Part A and Part B following fracture.

Medicare covers fall prevention counseling and interventions:

• Fall risk assessment during the Annual Wellness Visit (free)
• Physical therapy for balance and strength (Part B)
• Some Medicare Advantage plans cover fall prevention programs and home safety assessments

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.