What This Guide Covers About Medicare and Bone-Strengthening Programs
This informational guide explains how Medicare covers bone-strengthening programs and related services. The guide walks through the different types of coverage Medicare offers, what bone-strengthening programs may be covered, and what out-of-pocket costs you might encounter. Understanding these topics can help you make decisions about your health care.
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Medicare is a federal health insurance program that covers people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. As of 2024, more than 67 million people have Medicare coverage. The program has different parts that cover different services. Part A covers hospital care. Part B covers doctor visits and outpatient services. Part D covers prescription drugs. Many bone-strengthening treatments and programs fall under Part B coverage.
Bone health becomes increasingly important as we age. The National Institutes of Health reports that about 1 in 3 women over age 70 and 1 in 5 men over age 70 will experience an osteoporosis-related fracture in their remaining lifetime. Osteoporosis is a condition where bones become weak and fragile, making them more likely to break. Medicare recognizes the importance of preventing fractures and maintains coverage for several types of bone-strengthening interventions.
This guide provides factual information about what Medicare covers, how different bone-strengthening services work, and what you should know about costs. The information here can help you understand your options, but the guide itself does not determine coverage decisions or process any transactions. For specific questions about your individual Medicare coverage, you would need to contact Medicare directly or review your policy documents.
Practical Takeaway: Before reading further, gather your Medicare card and any plan documents you have. These will help you understand which parts of Medicare you currently use and will make it easier to reference specific coverage details as you review this information.
Understanding Medicare Coverage for Bone Health Screening and Testing
Bone density testing, also called a DEXA scan or DXA scan, is often the first step in understanding bone health. Medicare Part B covers bone density testing under specific circumstances. The test uses low-dose X-rays to measure how much mineral is in your bones. A lower mineral density can indicate weakened bones that are more prone to fracturing.
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Medicare Part B covers bone density testing for women age 65 and older, and for postmenopausal women who have risk factors for osteoporosis. The program also covers testing for men age 70 and older, and for younger men with risk factors. Risk factors include previous fractures, low body weight, certain medications like corticosteroids, and family history of osteoporosis. Medicare typically covers the test once every two years, though more frequent testing may be covered if medically necessary.
The actual cost you pay depends on your coverage plan. Original Medicare Part B usually requires you to pay 20 percent of the approved amount after you meet your Part B deductible, which was $240 in 2024. If you have a Medicare Advantage plan or a Medigap supplemental plan, your costs may be different. Many Medigap plans cover the 20 percent coinsurance, meaning you would pay little or nothing out-of-pocket for a covered bone density test.
Other bone health screening tests may also be covered. For example, if your doctor orders blood work to check vitamin D levels or other bone-related markers, these tests may be covered under Part B as part of your doctor's visit or as separate laboratory services. Your doctor can order these tests if they believe they are medically necessary based on your health situation.
It is important to understand that Medicare coverage for bone density testing requires that your doctor order the test and that you meet the age and risk factor requirements. The test must be performed at a facility that is enrolled in Medicare. Not all imaging centers offer bone density testing, so your doctor's office can direct you to an appropriate location.
Practical Takeaway: If you are a woman over 65 or a man over 70, discuss with your doctor whether a bone density test makes sense for your health. If your doctor recommends testing, verify that the imaging center accepts Medicare before scheduling your appointment. Keep records of when you have had bone density tests, as Medicare tracks this information to determine coverage for future tests.
Physical Therapy and Exercise Programs for Bone Strengthening
Physical therapy can help strengthen bones and improve balance, which reduces the risk of falls that could cause fractures. Medicare Part B covers physical therapy when it is prescribed by a doctor and deemed medically necessary. A physical therapist can design exercises specifically intended to improve bone density, increase muscle strength around the bones, and enhance balance and coordination.
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Medicare Part B covers physical therapy services provided in outpatient settings, including physical therapy clinics, hospital outpatient departments, and some home health settings. The therapist works with you to develop a treatment plan based on your individual needs and limitations. For someone with low bone density, this might include weight-bearing exercises, resistance training, and balance exercises. Weight-bearing exercises like walking or dancing put stress on bones in a way that encourages them to maintain or increase their density.
The number of physical therapy visits Medicare covers can vary. Traditional Medicare Part B covers physical therapy services subject to an annual limit. In 2024, the limit was $2,170 per year. However, this limit applies to combined physical therapy, occupational therapy, and speech-language pathology services. If your therapy is provided in a hospital outpatient department, different rules may apply. Medicare Advantage plans may have different visit limits and copayments.
Your out-of-pocket costs for physical therapy depend on your specific coverage. With Original Medicare Part B, you typically pay 20 percent of the approved amount after meeting your deductible. If you have a $100 copayment Medigap plan, you might pay as little as a copay per visit. Medicare Advantage plans usually charge a copayment per visit, which can range from $10 to $50 depending on the plan.
Group exercise programs specifically designed for bone health or fall prevention may also be covered. Some community centers and senior programs offer classes like Tai Chi for balance or water aerobics that can strengthen bones. If these classes are prescribed by your doctor and meet Medicare's requirements for medical necessity, some costs may be covered. However, general fitness classes not prescribed by a doctor are typically not covered by Medicare.
Practical Takeaway: Ask your doctor if physical therapy makes sense for your bone health. If prescribed, find a physical therapy provider that accepts Medicare assignment, which means they accept Medicare's approved amount as full payment. Before starting therapy, ask about your expected out-of-pocket costs and how many visits you might need.
Medications and Drug Coverage for Bone Strengthening
Several types of medications can help slow bone loss or increase bone density. These medications may be covered under Medicare Part D, which is prescription drug coverage. Common medications used to treat osteoporosis include bisphosphonates like alendronate (Fosamax) and risedronate (Actonel), as well as other drug classes like selective estrogen receptor modulators and monoclonal antibodies. The specific medications covered and the costs you pay depend on your Part D plan.
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Medicare Part D is available through standalone prescription drug plans or as part of Medicare Advantage plans that include drug coverage. Each Part D plan has a formulary, which is a list of covered drugs. Not all osteoporosis medications are on every formulary, and the cost-sharing amount can vary widely between plans. Some drugs may require prior authorization from your insurance company before they are covered, meaning your doctor must obtain approval before the pharmacy will fill your prescription.
The cost structure for Part D includes several phases. First, you pay a monthly premium, which varies by plan. Then you pay an initial deductible, which in 2024 was up to $545 depending on your plan. After meeting the deductible, you enter the initial coverage phase where you pay a copayment or coinsurance for each prescription. Once you and your plan have spent a certain amount on drugs—$5,150 in 2024—you enter a coverage gap sometimes called the "donut hole" where you pay a higher percentage of drug costs. Finally, after out-of-pocket costs reach a certain level, you enter catastrophic coverage where you pay a small copayment.
Generic versions of osteoporosis medications are often significantly less expensive than brand-name versions and may be equally effective. Ask your doctor if a