Does Medicare Cover Bone Density Tests?

What is osteoporosis?

Osteoporosis, or the weakening of bones with age, is a serious medical condition affecting one-third of women and one-fifth of men. It can lead to serious health issues, chronic pain, and even increased mortality. 

Our bones are regularly repaired by cells known as osteoblasts. These cells take minerals and combine them with proteins like collagen to create bone, a durable substance. Bone has excellent tensile and compressive strength. When bone is damaged, the osteoblasts begin mending them. 

Hormones, particularly estrogen, stimulate osteoblasts. Unfortunately, when women experience menopause, their bodies reduce estrogen production. This means that the osteoblasts aren’t getting signaled as strongly, reducing their activity. New bone matrix isn’t being built as the old bone gets brittle and weak, leading to an increased incidence of fractures. 

Osteoporosis is commonly considered a woman’s disease, but menopause isn’t the only risk factor. Anything that compromises bone density, from a lack of calcium in your diet to a sedentary lifestyle, can lead to osteoporosis, regardless of gender. Taking steroid-based medications can also interfere with estrogen levels, leading to osteoporosis symptoms.

How do bone density scans help?

If your doctor suspects you have osteoporosis, they’ll likely prescribe a bone density test. This can take one of two forms.

• You’ll may have an x-ray taken of your spine or hip at a hospital.
• Alternatively, a doctor or nurse may use a mobile device to take an x-ray of your finger, wrist, or heel. 

The test requires no special preparation and is non-invasive. Bone density tests typically take less than 15 minutes to complete. A doctor will compare the x-ray to a healthy adult at age 30, assigning a T-score to compare your bone density. If your T-score is -2.5 or lower, you’re officially diagnosed with osteoporosis. This can help reduce your risk of broken bones and fractures, but are bone density tests covered by Medicare?

Does Medicare pay for bone density tests?

So, does Medicare cover bone density tests? Bone density tests are covered under Medicare Part B, allowing eligible beneficiaries to receive a test every 24 months or more if necessary. However, you must meet one or more of the following conditions. 

• You’re a woman whose doctor determines you are estrogen-deficient and at risk for osteoporosis. 
• An x-ray you’ve received for another reason shows signs of osteoporosis, osteopenia, or vertebral fracture.
• You’re taking, or planning to begin taking, prednisone or another steroid-type drug.
• You’ve been diagnosed with primary hyperparathyroidism.
• You’re receiving drug therapy for osteoporosis.

While these tests can be expensive out-of-pocket, Medicare osteoporosis coverage can reduce your costs significantly. In fact, you’ll pay nothing for this test if you qualify for Medicare, though you’ll need to visit a provider that accepts Medicare.

However, there’s a caveat: bone density tests are only considered a preventive service for individuals who can undergo menopause, meaning cisgender women and other individuals born with ovaries. If you don’t fall under this category you’ll likely have a more challenging time getting a scan: a provider can still order it, but you’ll likely pay 20 percent of the cost unless you appeal to Medicare. 

If you have a Medicare Advantage plan, some or all of these eligibility requirements may be waived, and you may be eligible for more frequent bone density tests. Check with your provider for plan-specific information.

Other Medicare Osteoporosis Treatment

If you are diagnosed with osteoporosis, your treatment options vary. While increasing calcium and vitamin D intake can help, you will typically need prescription medication. This is another area where gender disparity can come into effect. 

There are several injectable osteoporosis medications Medicare Part B can provide, but only for women, and only if you cannot inject the medication yourself and have no one to inject it for you. Then, Medicare will send a nurse to administer the medication at your home. 

If you don’t meet those requirements, Medicare Part D will usually cover osteoporosis medication, as will Medicare Advantage plans that include Part D benefits. Be sure to check what is covered before seeking out any treatment.