Key Takeaways

  • Medicare Part A covers fractures or osteoporosis-related injuries requiring surgery or hospitalization, while Medicare Part B covers outpatient treatments for osteoporosis, such as injectable drugs like Prolia and medically necessary physical therapy.
  • Part B also covers osteoporosis screenings, including bone density tests every two years for those with low estrogen, X-ray evidence of osteoporosis, or those needing evaluation for osteoporosis medication effectiveness.
  • Medicare Part D covers self-administered drugs for osteoporosis, while Medicare Advantage (Part C) offers the same coverage as Original Medicare (parts A and B).

Generally, Medicare Part B should cover most outpatient screenings and treatments for osteoporosis, a condition that causes weakened, porous bones.

That said, if you experience a fracture or another osteoporosis-related injury that requires surgery or hospitalization, Medicare Part A will provide coverage.

In addition, if you have a Medicare Advantage (Part C) plan instead of Original Medicare (parts A and B), it should give you the same benefits.

Under Part B, Medicare covers various ways to measure bone density as part of an osteoporosis screening.

Part B will cover one test every 2 years if you meet certain criteria, including:

  • You are a female who has received a diagnosis of low estrogen and are at high risk of osteoporosis.
  • You are of any sex and have X-ray evidence of osteoporosis, low bone mass, or a vertebral fracture.
  • You are of any sex and are being evaluated for the effectiveness of osteoporosis medication.

Generally, Medicare covers osteoporosis treatments as follows:

  • Injectable drugs: Medicare Part B covers injectable drugs like Prolia and home health nurse visits for the injections if you’re a female with osteoporosis, qualify for Medicare home health, and have a related fracture. Plus, your doctor must confirm that you can’t self-administer the drug. In the hospital, Part A covers these instead of Part B.
  • Self-administered drugs: Part D covers self-administered drugs. Each Part D plan may cover different drugs, though. Some Part C plans also cover prescription drugs.
  • Physical therapy: Part B can cover this when it is deemed medically necessary by a doctor.
  • Surgery: Medicare Part A covers surgical procedures for osteoporosis.

In 2025, after you meet the $257 Part B deductible, Medicare will cover 80% of the cost of approved treatments, and you’ll be responsible for the remaining 20%.

Depending on your income, you may also have to pay a monthly premium that starts at $185 or higher. However, most people pay no premium for Part A.

You do need to meet a $1,676 deductible. After that, Part A will cover you while you are in the hospital as well as any procedures you have during that time and any postsurgery rehab. That said, additional costs accrue daily if your hospitalization exceeds 60 days.

Part D and Medicare Advantage plans are private, with varying premiums and deductibles. You can explore those available in your area on Medicare.gov.

When it comes to Part D coverage, your out-of-pocket cost also depends on what tier (level) the medication is placed in your plan’s formulary (list of covered drugs).