As we age, our bones become more fragile, increasing the risk of fractures and osteoporosis. Bone density tests, also known as bone mass measurements or DEXA scans, can help identify individuals who may be at higher risk for these conditions. But what about Medicare coverage for these tests? In this article, we’ll explore what beneficiaries need to know about Medicare coverage for bone density tests.
What is Medicare and how does it work?
Medicare is a federal health insurance program that provides coverage to individuals who are 65 years of age or older, as well as individuals with certain disabilities or health conditions. One of the many benefits of Medicare is coverage for preventive services, which includes bone density testing.
What are bone density tests and why are they important?
Bone density tests are a type of medical imaging that measures the strength and density of bones. These tests are important because they can identify individuals who are at risk for fractures and osteoporosis, which can lead to serious health complications, especially in older adults.
What does Medicare cover for bone density tests?
Medicare Part B covers bone density tests for eligible beneficiaries. To be eligible for coverage, you must meet certain criteria, including:
- You are a woman whose doctor determines that you are estrogen deficient and at risk for osteoporosis, based on your medical history and other factors.
- You have been diagnosed with osteoporosis, as confirmed by a bone density test.
- You have certain medical conditions or are taking certain medications that can cause bone loss, such as hyperparathyroidism, chronic kidney disease, or steroid treatments.
How often can you get a bone density test under Medicare?
Under Medicare, you can get a bone density test once every 24 months (or more frequently if medically necessary). However, some individuals may need more frequent testing, such as those with certain medical conditions or who are taking certain medications that can cause bone loss.
What are the costs and copayments for bone density tests under Medicare?
If you meet the eligibility criteria for bone density testing under Medicare, you will pay 20% of the Medicare-approved amount for the test. This means that you will be responsible for the remaining 20% of the cost after Medicare pays its share. The actual cost will vary depending on the provider and location where you receive the test.
What are some exceptions and special cases for bone density test coverage under Medicare?
There are some exceptions and special cases for bone density test coverage under Medicare. For example, if you have a bone density test in a hospital outpatient setting, you may have to pay a copayment. Additionally, if you have a bone density test less than 23 months after your last test, Medicare may not cover the test.
Other preventive services related to bone health covered by Medicare
In addition to bone density testing, Medicare covers other preventive services related to bone health. For example, Medicare covers osteoporosis screening, which can help identify individuals who are at risk for this condition. Medicare also covers vitamin D supplements for individuals who are at risk for vitamin D deficiency.
References:
https://www.medicare.gov/coverage/bone-mass-measurements