A Guide to Osteoporosis Medicare Coverage

October 2, 2019

• Fitness & Health
• Medicare

Osteoporosis literally means “porous bone”. It’s characterized by low bone mass and deteriorating bone tissue and it leads to fragile bones and an increased risk of hip, spine, and wrist fractures.

According to the International Osteoporosis Foundation (IOF), more than 61 million people will be affected by osteoporosis or low bone density by 2020. If you’re one of those millions of people and you have Medicare, you may wonder about osteoporosis Medicare coverage and what you can do to help your bone health.

Osteoporosis Medicare Treatment and Testing Coverage

Original Medicare covers certain preventive services and treatments for osteoporosis.

Does Medicare Cover Bone Density Tests?

As part of Medicare’s preventive care program, Medicare Part B may cover one bone density test every two years—more often if the tests are medically necessary—if you meet one or more of the following conditions:

• You’re a woman whose doctor determines you’re at risk for osteoporosis, based on estrogen deficiency, your medical history, and other risk factors
• Your X-rays show possible osteoporosis, osteopenia, or spine fractures
• You take prednisone or steroid-type drugs or you plan to start
• You have primary hyperparathyroidism
• You’re monitored to see if your osteoporosis drug treatment is working

Does Medicare Cover Prolia Injections and Other Osteoporosis Drugs?

Original Medicare (Part A and Part B) may help pay for an injectible drug for osteoporosis (Prolia, Reclast, or other drugs) and visits by a home health nurse to inject the drug if you meet the following conditions:

• You’re a woman.
• You’re eligible for Part B and qualify for Medicare home health services.
• You have a bone fracture that a doctor certifies is related to postmenopausal osteoporosis.
• Your doctor certifies that you’re unable to learn to give yourself the drug by injection and your family members and/or caregivers are unable and unwilling to give you the drug by injection.

You may owe coinsurance and/or deductibles. You may be responsible for paying other services in full if Medicare doesn’t approve them.

Prolia Finder

If you don’t know where to get started looking for Prolia, click here. That will lead you to the Prolia finder tool. Enter your zip code in the box above the blue arrow. We used our home office in Nashville, Tennessee’s zip code, which is 37209.

Then select “Pharmacy Site” in the drop-down menu above the red arrow. Then click “Find Locations” beside the yellow arrow. That will lead you to a list of pharmacies where you can find Prolia. You may have to contact more than one to find the right facility for you.

The next step is going to your pharmacy and picking up your medication. You may owe Part D or Medicare Advantage drug fees. Once you obtain the medication, make an injection appointment with your healthcare provider.

You can also receive an injection at a Prolia treatment site, which you can find using the same Prolia finder tool.

To find a treatment location, go through the same steps to find a pharmacy site, except select “Treatment Site” from the drop-down menu above the red arrow. After you click “Find Locations” you’ll reach a list of Prolia treatment sites and contact information. Again, you may have to call more than one to find the best fit.

Medicare Coverage for Other Osteoporosis Drugs

In most cases, Original Medicare doesn’t include prescription drug coverage. If your doctor prescribes ibandronate (Boniva), alendronate (Fosamax), and/or risedronate (Actonel, Atelvia) and you want Medicare coverage, you’ll need to enroll in either a Medicare Part D plan or a Medicare Advantage plan with a prescription drug benefit.

How to Increase Bone Density at Home

Along with taking your prescribed medications, there are many things you can do to help increase your bone density at home. According to the National Osteoporosis Foundation (NOF), you can protect your bones by exercising, eating right, avoiding tobacco, and limiting alcohol. 

Exercises for Osteoporosis

The two most important types of osteoporosis are weight-bearing and muscle-strengthening exercises. Both types of exercises can help build and maintain bone density. As always, you should check with your healthcare provider before starting any exercise program.

Weight-Bearing Exercises

Weight-bearing exercises include activities that make you move against gravity while staying upright. Weight-bearing exercises can be high-impact or low-impact.

High-impact weight-bearing exercises help build bones and keep them strong. However, you may need to avoid high-impact exercises if you have a broken bone. 

Some examples of high-impact weight-bearing exercises:

• Dancing
• High-impact aerobics
• Hiking
• Jogging/running
• Jumping Rope
• Stair climbing
• Tennis

Low-impact weight-bearing exercises are also effective at keeping bones strong. They’re also a safe alternative if you can’t do high-impact exercises. 

Some examples of low-impact weight-bearing exercises:

• Using elliptical machines
• Doing low-impact aerobics
• Using stair climbers
• Brisk walking on a treadmill or outside

Muscle-Strengthening Exercises

Muscle-strengthening exercises use a weight or some other resistance to push or pull against gravity. They are also known as resistance exercises and include:

• Lifting free weights
• Using weight machines
• Using elastic exercise bands (resistance bands)
• Lifting your own body weight (pull-ups, pushups, etc.)
• Functional movements that you use in daily life, such as standing from a sitting position

Yoga and pilates can also help improve strength, balance, and flexibility. However, certain positions may not be safe for people with osteoporosis or low bone density. If you have questions about the safety of an exercise, consult your doctor or physical therapist.

Medicare Fitness Coverage

Original Medicare does not cover gym memberships or fitness classes. However, certain Medicare Advantage plans offer coverage for fitness classes along with other supplemental benefits such as dental, hearing, and vision coverage. 

A licensed agent with Medicare Plan Finder may be able to help you find a plan that suits your needs. Plans vary by zip code, but some Medicare Advantage with fitness benefits have $0 premiums. To set up a no-cost, no-obligation appointment, call 844-431-1832 or contact us here.

Diet for Osteoporosis

According to NOF, a “balanced diet that’s rich in calcium and Vitamin D” is important for your bone health. 

NOF says the following foods are good for your bones because they may contain nutrients such as magnesium, potassium, Vitamin C, and Vitamin K along with Vitamin D and calcium:

Dairy Products

• Low-fat milk, yogurt, and cheese
• Non-fat milk, yogurt, and cheese

Fish

• Canned sardines and salmon (with bones)
• Fatty varieties such as salmon, mackerel, tuna and sardines

Fruits and Vegetables

• Artichokes
• Bananas
• Beet greens
• Broccoli
• Brussels sprouts 
• Chinese cabbage
• Collard greens 
• Dandelion greens
• Kale
• Mustard greens
• Okra 
• Oranges
• Papaya
• Pineapple
• Plantains
• Plantains
• Potatoes including sweet potatoes
• Red peppers, green peppers, 
• Spinach
• Tomato products
• Turnip greens

Fortified Foods

Some food manufacturers add Vitamin D and calcium to products such as cereal, juice, and bread. Always check the product’s label to see exactly what’s in the container.

Find Osteoporosis Medicare Coverage Today!

Talk to one of our agents if you want to learn more about Medicare’s coverage for osteoporosis. Our licensed agents are highly trained and they may be able to help you find a plan that fits your budget and lifestyle. 

If you’ve been diagnosed with low bone density or osteoporosis, you may need treatment as quickly as possible. One of our agents can show you what’s available in your location. Call 844-431-1832 or contact us here to arrange a meeting now.