Original Medicare covers bone mass measurements with a doctor who deems it medically necessary, and it’s been at least 24 months since your last scan. Although, under certain circumstances, more frequent testing is possible.
Read the content below to learn everything you need about Medicare coverage for bone mass testing. We’ll go over the different plan types and coverage you can expect. Then, we’ll answer a few questions on bone density testing.
Does Medicare Cover Bone Density Tests
Those with Original Medicare have coverage for a bone density scan. If medical care occurs in an inpatient setting, then Medicare Part A covers the test.
Beneficiaries undergoing an outpatient bone mass measurement test can expect Medicare Part B to cover the scan. Medicare Part B covers a Bone Mass Measurement test every 24 months or more if it’s medically necessary.
The bone density test is considered a preventive service. If the healthcare provider accepts the Medicare assignment, you’ll pay nothing for this test. That includes no deductible or coinsurance.
At least one of the following must apply:
- You’re a woman, and your doctor determined through your medical history or other findings that you’re estrogen-deficient and at risk for osteoporosis.
- Your x-rays show possible vertebral fractures, osteopenia, or osteoporosis.
- You’ve been diagnosed with primary hyperparathyroidism.
- You’re taking prednisone or steroid drugs. Or, you’re planning this type of treatment.
- Your doctor monitors you to see if osteoporosis drug therapy works for you.
To qualify for more frequent testing, you’ll need to have one of the following conditions:
- Rheumatoid Arthritis
- Chronic kidney disease
- Overactive parathyroid gland
- Qualifying hormonal imbalance
- Organ transplant
The bone density test must be medically necessary and ordered by your doctor. Also, the facility that does testing must accept Medicare or Medicare Health Insurance for you to have coverage.
Suppose you have low calcium intake or a Vitamin D deficiency. You may have a higher risk for low bone density in that case.
Medicare Advantage Coverage for Bone Mass Measurement Testing
Medicare Advantage plans cover bone mass measurement testing since Medicare covers the test. Part C plans may cover extra Medicare benefits such as transportation to your bone density scan. Plan options vary depending on your location. Check with your insurance company for health plan specifics.
Medicare Supplements Coverage for Bone Mass Density Testing
Medigap plans approve testing when Medicare approves the test. You can go to any doctor or hospital in the United States if they accept Medicare.
Medicare Supplement plans don’t require a referral to a specialist, making these plans convenient, especially for those with significant health concerns.
Part D Coverage for Medications for Those With Low Bone Density
Medicare Part D drug plans can help cover osteoporosis medications. The formulary has information on which drugs have coverage.
You can talk to a licensed insurance agent about Part D plans and medical insurance. An agent can help you find the policy that makes the most sense for you.
How often can Medicare patients have a bone density test?
Medicare beneficiaries can generally get the bone density test done every 24 months. However, under certain circumstances, you may qualify for more frequent testing. For example, those with osteoporosis risk factors, frequently broken bones, or a high risk of fractures may be eligible for additional testing. Talk to your doctor about your bone health. They can provide you with medical advice.
What is the difference between a bone density test and a bone mineral density test?
A bone density test can determine if you have osteoporosis. However, bone mineral density tests measure the number of minerals in your bones.
Does Medicare cover dual-energy X-ray absorptiometry (DEXA)?
In most cases, Medicare coverage for DEXA is available under Part B. Doctors may call this test a DXA test. Either way, it’s a way to measure bone loss. These tests are also known as bone densitometry tests.
How Can Medicare Coverage For Your Bone Density Test
Medigap plans fill the holes of Medicare. Instead of paying high deductibles and 20% coinsurance for every doctor visit for your medical conditions, you can put most of that burden onto the Medigap insurer. Low bone density can lead to broken bones and costly hospital bills.
Call a licensed insurance agent at the number above to get started on your Medigap enrollment. Or, fill out an online rate comparison form to view the plans in your area side by side.