Does Medicare Cover Osteoporosis? 

You might think that osteoporosis is a disease that only affects older women, but the truth is that men are affected by osteoporosis at almost the same rate as women. Some studies have demonstrated that about 30% of women are at risk of developing this condition at some point in their lives. Between 13% and 35% of men are at risk.

Although gender doesn’t seem to matter as much when it comes to who is affected by osteoporosis, age is a bigger factor. The risk of developing osteoporosis goes up with age, and this is especially troubling for seniors who are also at a greater risk of experiencing falls, bone fractures and breaks.

What causes osteoporosis to develop?

The reason osteoporosis is more prevalent in older women is due to the lower levels of estrogen that come along with aging post-menopause. A lack of estrogen can cause a woman’s bones to become more brittle and susceptible to osteoporosis and damage.

For men, hormones can play a part in the development of osteoporosis, but diet and lifestyle are often greater factors. Calcium deficiency and low intake of vitamin D can weaken bone structure, and certain medications like glucocorticoids can also contribute to the development of bone diseases.

How is osteoporosis treated?

Osteoporosis has no cure, but its effects can be mitigated and progression can be slowed. Treatment for osteoporosis depends on the cause as well as your overall health and lifestyle choices. For some seniors, changing a diet to include more calcium and vitamin D may be all that’s needed. Weight management and exercise are also usually recommended for seniors who are at risk of developing osteoporosis.

Medications are another treatment option for some retirees who experience osteoporosis. Prescription drugs for osteoporosis include oral medications and injections that are designed to stimulate bone growth and strengthen existing bone tissue. In some cases, prescription medications can regrow portions of bone that have been lost to osteoporosis while halting further bone loss.

Does Medicare cover osteoporosis?

Osteoporosis may be covered through the different parts of Medicare, depending on the severity of your condition and your personal needs.

How Medicare covers inpatient osteoporosis treatment

Medicare Part A is known as hospital coverage. If you require treatment for osteoporosis while admitted to a Medicare-participating hospital, Medicare covers all costs for 60 days each benefit period. If you qualify, Medicare will also cover care for a limited time in a skilled nursing facility (SNF) including $0 copayment for days 1-20. Medicare coverage for inpatient care covers expenses that are medically necessary. Any medications provided by injection or given orally are also covered under Medicare Part A during your admittance.

How Medicare Part B covers outpatient osteoporosis treatment

Medicare benefits are also available for outpatient osteoporosis treatment. Outpatient visits with your doctor or a specialist are covered at 80% under Medicare Part B. You can also rely on Medicare coverage for diagnostic testing and durable medical equipment (DME) through Part B. If you are prescribed the use of a mobility device like a walker or wheelchair, Medicare Part B supplies coverage as long as you meet the criteria and the DME comes from a Medicare-approved supplier.

How Medicare Part D covers prescription drug coverage for osteoporosis

Medication support for osteoporosis comes in the form of Medicare Part D. This part of your Medicare insurance plan only covers medications that can be purchased from a local pharmacy or mail order company for use at home. Depending on the plan you’re enrolled in, you may need to purchase your medications from specific pharmacies within the plan’s network. Medications covered by Part D may require a copay, and not all medications are covered by each plan. You will need to look through your plan’s formulary to find out if your specific medications are covered and to what extent.

Medicare Advantage also covers osteoporosis treatment

Osteoporosis treatment is also available through Medicare Advantage plans. These plans are include the Part A and Part B benefits of Original Medicare, but most MA plans include additional benefits. A Medicare Advantage plan provider may offer extra coverage that helps seniors experiencing the effects of osteoporosis, including access to workout programs designed for the needs of older Americans.

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