Medicare Coverage for Osteoporosis: 2025 Guide

Osteoporosis affects an estimated 10 million Americans over 50, and another 44 million have low bone density. Despite Medicare covering free bone density tests every 24 months and several effective medications, only about 20% of patients who suffer an osteoporotic fracture are prescribed bone-protective medication afterward. Here's what Medicare covers — and how to avoid the treatment gap that leads to repeat fractures.

Osteoporosis Coverage Quick Reference

Bone Density Tests: Free Every 2 Years

Medicare Part B covers bone mass measurement (DEXA scan) at no cost to you — $0 copay, no deductible — when you have one or more of these qualifying conditions:

• A woman whose doctor determines she is estrogen-deficient and at risk for osteoporosis
• You take glucocorticoid (steroid) medications long-term (prednisone, prednisolone, etc.)
• You have been diagnosed with primary hyperparathyroidism
• You are receiving or being monitored after osteoporosis drug therapy
• Your X-ray shows possible osteoporosis, osteopenia, or vertebral fracture

Coverage is every 24 months (about once every 2 years) or more frequently if medically necessary. Talk to your doctor — most women over 65 and men over 70 qualify automatically.

Injectable Medications Under Part B: The Coverage Advantage

Two of the most effective osteoporosis medications are covered under Medicare Part B — not Part D — because they are physician-administered injections rather than self-administered prescriptions. This distinction matters significantly for cost:

Denosumab (Prolia)

Prolia is injected by a healthcare provider every 6 months. Because it's physician-administered, it falls under Part B coverage:

• You pay 20% of the Medicare-approved amount
• For Prolia, 20% can still be substantial (Prolia costs approximately $1,200–$1,400 per injection)
• Medigap Plan G covers the 20%, making Prolia effectively free (after the Part B deductible)
• Important: If you stop Prolia without transitioning to another medication, bone density can decline rapidly — discuss with your doctor before discontinuing

Zoledronic Acid (Reclast)

Reclast is an IV infusion given once per year in a physician's office or infusion center:

• Covered under Part B at 20% coinsurance
• Highly effective for both osteoporosis treatment and prevention of fracture recurrence after hip fracture
• Often preferred for patients who have difficulty tolerating oral bisphosphonates (esophageal issues, absorption problems)
• Medigap Plan G covers the 20%

Oral Medications Under Part D

Oral bisphosphonates — the most common first-line treatment — are covered under Medicare Part D. Generic versions are widely available and typically very affordable:

• Alendronate (generic Fosamax): Usually Tier 1; cost often $5–$15/month with Part D
• Risedronate (generic Actonel): Usually Tier 1–2; similarly low cost
• Ibandronate (generic Boniva): Tier 1–2; monthly dosing option

Anabolic agents (Forteo, Tymlos) and newer agents (Evenity) are typically Tier 3–4 under Part D and can be expensive without Medigap or Extra Help. These are reserved for patients with severe osteoporosis or very high fracture risk — but if you need them, compare Part D plans carefully during the Annual Election Period.

The Post-Fracture Treatment Gap

This is one of the most significant quality gaps in osteoporosis care — and Medicare covers the tools to fix it:

Research consistently shows that only about 20% of patients who suffer a major osteoporotic fracture (hip, spine, wrist) receive appropriate bone-protective medication after the fracture. This is sometimes called the "osteoporosis treatment gap" or "post-fracture care gap."

Why this matters: After a hip fracture, the risk of a second major fracture within 12 months is dramatically elevated. Up to 25% of patients who suffer a hip fracture die within one year. Bisphosphonates or other treatment significantly reduces this risk.

If you or a family member has a fracture: Before hospital discharge, ask the attending physician or hospitalist: "Will you prescribe or arrange for osteoporosis treatment?" If not, ask the orthopedic surgeon. If the fracture liaison service (FLS) program is available at your hospital, request a referral — this program specifically addresses the post-fracture treatment gap.

Falls Prevention: Physical Therapy and Exercise

Medicare covers outpatient physical therapy under Part B for balance training and fall prevention. This is particularly important for osteoporosis patients because falls cause the fractures.

• No hard annual session cap — therapy continues as long as medically necessary
• Balance training, strength training, and gait training are all covered services
• Home health physical therapy (at no cost) if you are homebound
• Annual wellness visit includes fall risk assessment — ask your doctor about this screening

Hip Fracture: The Most Expensive Consequence

Hip fracture hospitalizations and rehabilitation are covered under Medicare Part A, but the costs add up quickly without Medigap:

• Hospital stay: $1,676 Part A deductible per benefit period
• Surgery (surgeon + anesthesia): Part B 20% coinsurance — surgeon fees can be $2,000–$5,000+, making your 20% share $400–$1,000
• SNF rehabilitation: $0 for days 1–20, then $209.50/day for days 21–100
• A 30-day SNF stay after hip fracture costs $2,093 in coinsurance for days 21–30 alone

Medigap Plan G eliminates the 20% Part B coinsurance on surgeon fees and covers the $209.50/day SNF coinsurance for days 21–100.

What Medicare Does NOT Cover for Osteoporosis

• Calcium and vitamin D supplements: Over-the-counter supplements are not covered — even though they're universally recommended for osteoporosis patients
• Long-term custodial care: If a hip fracture leads to permanent disability requiring ongoing assistance, Medicare's SNF benefit ends at 100 days. Long-term nursing home care is not covered
• Vertebroplasty/kyphoplasty (fracture repair): Medicare covers these procedures when medically necessary, but coverage is case-specific and has been under scrutiny

Frequently Asked Questions