Medicare does cover osteoporosis treatment, including bone density testing, prescription medications, and in some cases injectable drugs administered at home. The coverage is split across different parts of Medicare, and what you’ll pay out of pocket depends on which part covers the specific service or drug.
Bone Density Testing Under Part B
Medicare Part B covers bone mass measurements (DEXA scans) once every 24 months, or more frequently if your doctor determines it’s medically necessary. You qualify if you meet at least one of these conditions:
- You’re a woman determined to be estrogen-deficient and at risk for osteoporosis
- Your X-rays show signs of osteoporosis, osteopenia, or vertebral fractures
- You’re taking or planning to take prednisone or other steroid-type drugs
- You’ve been diagnosed with primary hyperparathyroidism
- You’re being monitored to see if your osteoporosis medication is working
Part B’s standard cost-sharing applies: after you meet the annual Part B deductible, you typically pay 20% of the Medicare-approved amount for the scan. If your provider accepts Medicare assignment, that 20% coinsurance is your only cost. A Medigap (supplemental) policy can cover part or all of that coinsurance.
Oral Medications Under Part D
The most commonly prescribed osteoporosis drugs are oral bisphosphonates, pills you take weekly or monthly to slow bone loss. These fall under Medicare Part D, your prescription drug plan. CMS specifically lists osteoporosis among the drug classes it monitors to ensure Part D plans provide adequate coverage, and oral bisphosphonates are confirmed as eligible for Part D benefits.
What you actually pay depends on your plan’s formulary and which tier the drug lands on. Tier 1 carries the lowest copay, with costs rising on higher tiers. Generic bisphosphonates are widely available and often placed on lower-cost tiers, keeping copays relatively modest. Brand-name medications for osteoporosis tend to sit on higher tiers with steeper cost-sharing, sometimes 25% coinsurance or more during the initial coverage stage.
A significant protection: Part D now caps total out-of-pocket drug spending at $2,100 per year (the 2026 figure). Once your qualifying out-of-pocket costs hit that threshold, you move into catastrophic coverage and pay nothing further for covered drugs the rest of the year. This cap is especially relevant if you’re prescribed newer, more expensive osteoporosis medications that can cost hundreds or thousands of dollars monthly.
Injectable Drugs Given in a Doctor’s Office
Some osteoporosis treatments are injections given at a clinic or doctor’s office. These are generally covered under Part B rather than Part D, because Medicare classifies drugs administered by a healthcare professional in a clinical setting as medical services. One example is romosozumab (Evenity), a monthly injection given in pairs at your provider’s office. Because it’s administered on-site, it’s billed through Part B, and you’d pay the standard 20% coinsurance after your deductible.
Other injectables work differently. Teriparatide (Forteo) is a daily self-injection you give yourself at home, which typically places it under Part D rather than Part B. The generic version has brought costs down from thousands to hundreds of dollars per month, but your actual copay still depends on your Part D plan’s formulary and tier placement.
Home Injections Under Part B
Part B does cover injectable osteoporosis drugs administered at home, but the eligibility criteria are narrow. All three of these conditions must be met:
- You qualify for Medicare home health services
- You have a bone fracture that your doctor certifies is related to postmenopausal osteoporosis
- Your doctor certifies that you can’t give yourself the injection or learn to do so, and your family members or caregivers are unable or unwilling to administer it
This benefit is limited to women with postmenopausal osteoporosis. If you meet all three requirements, a home health nurse can come to your home to give the injection, and Part B covers both the drug and the nursing visit. If you don’t meet these criteria, the same injectable drug would need to be covered through Part D instead, with different cost-sharing.
Medicare Advantage Plans
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan must cover everything Original Medicare covers, including bone density tests and the same drug categories. However, there are practical differences. Medicare Advantage plans can require prior authorization before covering certain services or medications. With Original Medicare, prior authorization is rarely needed.
This means your Advantage plan might require your doctor to submit paperwork justifying why you need a particular osteoporosis drug before it approves coverage. The process can add days or weeks before you start treatment. If your plan denies coverage, you have the right to appeal. Advantage plans also have their own formularies for Part D drug coverage, so the specific medications covered and the tier placements can vary from one plan to another.
Filling the Coverage Gaps
The biggest out-of-pocket costs for osteoporosis care tend to come from expensive brand-name medications rather than the bone density scans themselves. If your doctor recommends a newer or brand-name drug, a few steps can reduce your costs. First, check whether your Part D plan’s formulary covers the specific drug and which tier it’s on. You can do this through Medicare’s Plan Finder tool or by calling your plan directly. Second, ask your doctor if a lower-tier alternative, such as a generic bisphosphonate, would be appropriate for your situation.
If you’re on Original Medicare and find that the 20% coinsurance for Part B services adds up, a Medigap policy can help cover those costs. For Part D expenses, the Extra Help program (also called Low-Income Subsidy) is available to people with limited income and resources, significantly reducing premiums, deductibles, and copays on prescription drugs. You can apply through Social Security or your state Medicaid office.