May is National Osteoporosis Month – a good time to spread awareness of osteoporosis, a condition that weakens the bones. The risk for osteoporosis increases with age, but with the right treatment, it doesn’t have to stop you from living life boldly. Let’s discuss more about osteoporosis and how Medicare can help you pay for screenings and treatment.

What is osteoporosis?

As we get older, we start to lose more bone than we build, resulting in lower bone density. Osteoporosis is a medical condition that occurs when bone density and mass decrease, or when the quality or structure of bone changes. Weak bones lead to a risk for breaks and fractures and broken bones can be a serious problem as we get older. With proper screening and treatment recommendations from your health care provider, managing an osteoporosis diagnosis is possible.

Risk factors for osteoporosis include:

• Sex: Women have lower peak bone mass than men.
• Race: White and Asian women are at the highest risk for osteoporosis.
• Changes to hormones: Low levels of certain hormones can increase your chances of developing osteoporosis, including low levels of estrogen and testosterone.
• Diet: A diet low in calcium and vitamin D can increase your risk of developing osteoporosis.

Can I get tested for osteoporosis?

Bone density tests help to find out if you’re at risk for broken bones, and they are the only test to formally diagnose osteoporosis and to monitor the effectiveness of ongoing treatments. Identifying and treating osteoporosis helps prevent reparative treatments like hip surgeries later on. The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, noninvasive test. If you have any questions about bone density screening, we recommend that you reach out to your doctor or healthcare provider.

Does Medicare cover bone density tests?

Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare Part B covers bone density tests every two years or more often as medically necessary. Your scan will be covered if your doctor has ordered the test and the facility where the scan is done accepts Medicare.

You may need more frequent bone density tests if:

• You’re a woman and your doctor determines you’re estrogen-deficient and at risk
• Your X-ray shows possible osteoporosis, osteopenia, or vertebral fractures
• You’re taking prednisone or steroid-type drugs or planning to begin this treatment
• You’ve been diagnosed with primary hyperparathyroidism
• You’re being monitored to see if osteoporosis drug therapy is working

To manage bone density loss, Medicare coverage will reduce your share of the cost of bone scans. If you meet the requirements and your doctor accepts Medicare, then you will not have to pay copays or the Part B deductible. To make sure you don’t have any unexpected expenses, check with your doctor or other health care provider. They should be able to help you understand why you need certain tests, items or services, and if Medicare will cover them.

A Medicare Advantage plan like ApexHealth covers the same services as Original Medicare. Just remember, you must have your test done within your plan’s provider network. If you are an ApexHealth member and you have any questions about your coverage, ask your ApexAssistant.

How is osteoporosis treated?

There are medicines available to treat osteoporosis by slowing the rate of bone loss and increasing bone strength. It can be treated by oral tablets or liquid medicine or by injectable drugs.

You may also be able to improve your condition with lifestyle changes. In addition to a healthy diet with plenty of vitamin D and calcium, there are a few lifestyle choices you can make to help optimize your bone health:

• Stop smoking and avoid secondhand smoke
• Drink alcohol in moderation
• Schedule regular checkups with your doctor and ask about any risk factors to your bone health including medications
• Exercise regularly to build muscle mass and strength, lower your risk of falling, and improve daily function. Make sure you check with your healthcare provider to recommend activities that will not put any sudden strain on your bones.

Does Medicare cover osteoporosis medications?

Medicare can cover your osteoporosis treatment in a few ways. You can enroll in a standalone Part D prescription drug plan or a Medicare Advantage plan with Part D coverage (MAPD). Look at the plan’s drug list to confirm that your osteoporosis medication is covered. Medicare Part A and Part B do cover osteoporosis drugs under certain conditions.

If you’re wondering what osteoporosis medications are covered by ApexHealth, visit our online search tool to find covered prescriptions and pharmacies. Or ask an ApexAssistant to do the searching for you!

With the help of bone density tests and a doctor or healthcare provider recommended treatment plan, osteoporosis can be manageable. If you have any questions, give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31. For all matters related to your medical health, we recommend contacting your doctor or healthcare provider.

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