Osteoporosis and Bone Density test coverage under Medicare is essential for seniors. There are about 10 million people in the United States alone with Osteoporosis and almost 34 million more with low bone mass.
Part of overall healthy living includes the health of your bones, starting from infancy and throughout your life. Your bones work as a “storage facility” of sorts for critical vitamins and minerals like calcium, which works to help support many of your body’s organs.
Bones can help protect your body against injuries and allow motility to complete daily tasks and daily living.
What is Osteoporosis
Osteoporosis is a bone disease where both the quality and density of your bones are lower than average.
The term osteoporosis means “porous bone,” and as your bones become more porous and weak, fractures are likely to occur.
Bones loss is a progressive condition, and many times; people will not notice any symptoms other than a fractured bone.
Since we all only get one body to live life in, it’s essential to work to make our bones as healthy and robust as they can be, no matter your age.
A significant first step you can make towards proper bone health is prevention and detection of Osteoporosis as soon as possible.
Fortunately, Medicare feels that bone health is essential and can help you get excellent bone care, whether it be testing or treatment.
What are Bone Mass Measurements
A bone bass measurement helps to check for your propensity of risk for fractured bones. The hip and spine bone is the ideal place of testing.
A central Dual-energy X-ray Absorptiometry is the machine that conducts the test.
Medicare Coverage of Bone Mass Density Tests
Your Part B benefits cover a dense bone measurement every two years; unless you need more because it’s essential.
It’s necessary if you meet a minimum of one of the following conditions:
- X-rays show the potential of osteoporosis, fractures, or osteopenia.
- You’re on prednisone or other steroid medications
- You’re a female, and your doctor has deemed you as estrogen-deficient.
- You have hyperparathyroidism
Many seniors need bone density testing, talk to your doctor about your eligibility. If your doctor decides to approve of the procedure, you won’t be responsible for payment.
Who’s Commonly Affected by Osteoporosis
While both women and men can be affected by osteoporosis, this common ailment typically affects women. One-third of fractures of the hips are found in men, while women make up about two-thirds of hip fractures around the world.
This condition usually peaks in people over the age of 50 years old. Several things commonly come into play with individuals who are affected by osteoporosis.
Some of the most significant fundamental factors are:
- Gender and Race – Caucasian and Asian women with small body frames tend to have a higher chance of facing this condition.
- Habits – Studies show that people using an excess of alcohol, cigarette smoking, lack of calcium, infrequent exercise, and heavy caffeine intake can lead to the onset of osteoporosis.
- General Health – If a person deals with poor health and lack of nutrition, they may find themselves more susceptible to osteoporosis.
- Hormones – Menopause or a hysterectomy can cause osteoporosis because of lower estrogen levels.
- Chronic Conditions – Several chronic conditions can negatively impact your bones, like Rheumatoid Arthritis or Hepatitis C.
Medication Used to Treat Osteoporosis
A typical prescription medication used in the treatment of osteoporosis is medication Prolia. Prolia is an injectable medication.
While many times Parts A and B do not cover prescription medications, it often time does include osteoporosis medications such as Prolia.
You may get prescriptions through Medicare if your bone broke due to menopausal osteoporosis, and you get home care.
If you’re fortunate to get prescriptions through Medicare, you can expect to pay 20% of the cost of the medication as well as your Part B deductible.
Medicare Coverage of Prescription Medications
Your hospital coverage and your medical coverage can help cover injectable prescriptions and even a nurse to help with injections.
To get coverage, you must meet the following qualifications:
- Must be eligible for Medicare’s home health care services and Part B
- You must be a woman
- You doctor must certify that you can’t inject the medication by yourself or take injections from a family member
- Your doctor confirms that your bone fracture is directly related to osteoporosis brought on by menopause
You must pay for 20% of Medicare’s amount for the cost of the medicine. Also, you must pay for your Part B deductible.
If a home health care nurse helps with injections, you won’t be responsible for those costs.
Medicare Advantage and Osteoporosis
A Medicare Advantage plan must cover at least as good as Medicare. There is no coinsurance, copayment, or deductible for bone mass testing.
The following have coverage every two years or more when necessary:
- Identify bone mass
- Detect bone loss
- Determine bone quality
These tests include a doctor’s interpretation of the results. Also, injectable osteoporosis drugs have coverage under Part B when you have a post-menopausal fracture and can’t administer the medication yourself.
If you get the injection, you need to pay 20% of the cost, even with most advantage plans. Each advantage plan varies, check the programs in your area to find the best one for you.
Medicare Supplement and Osteoporosis
Supplemental plans fill in the gaps by covering the 20% you would otherwise pay. By relieving you of this cost, you can worry less about bills and more about recovery.
The best part about a supplement is that when Medicare approves a service, the supplement must authorize the service as well. Knowing this gives many beneficiaries peace of mind.
If you think you’d benefit from Supplemental coverage, give us a call at the number above and speak with our expert team of agents. We’ll take the time to provide you with the information to compare as well as select the right plan.
Also, if you have a plan and want to find a lower premium, contact us today! If you don’t feel like calling in now, compare rates online!