Bone density tests are used the measure the amount of calcium and other trace minerals in your bones with x-rays. The results of these will help your doctor determine if you are at risk of a bone fracture due to an underlying condition. Read on to learn more about how Medicare covers this important test.
Key Takeaways
- Bone density tests are used to diagnose a person suffering from a degenerative bone condition, such as osteoporosis.
- Bone density tests are usually conducted with x-rays that are diagnosed at an outpatient facility.
- Bone density tests are usually done every 24 months for qualifying patients.
- Bone density tests may be done more frequently if the patient suffers from certain conditions.
- Medicare beneficiaries pay no costs for bone density tests as long as their doctor accepts Medicare assignmentAn agreement by your doctor to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.....
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... will cover bone density tests, but the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs.... will have to use providers within the plan.
Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare... covers the full cost of bone density testing every 24 months, but only if you meet the prerequisite conditions. That means you pay nothing out-of-pocket if you meet the three criteria.
What Are Bone Density Tests?
Bone density tests help your doctor diagnose any fractures and problems with bone density, such as osteoporosis or compression fractures. Bone density is usually measured with an imaging test like an X-ray, which will reveal the calcium density in your bones. If your bones are fragile, you will see large honeycomb-like structures when the doctor looks at your bones on a microscopic level.1mayoclinic.org, “Bone density test“, Accessed November 11, 2021
How Does Medicare Cover Bone Density Tests?
As we age our bones become more porous and fragile. Bone scans help your physician diagnose fractures and problems with bone density, such as osteoporosis. For this reason, Medicare covers bone scans every other year for the following conditions:2Medicare.gov, “Bone mass measurements“, Accessed November 11, 2021
- Estrogen deficient women at risk for osteoporosis
- Symptoms of osteoporosis, osteopenia, or vertebral fractures on an x-ray
- Prednisone or steroid-type drug use as part of a treatment plan
- Primary hyperparathyroidism
- Osteoporosis drug therapy monitoring
The conditions for coverage are:
- Your doctor has ordered the scan as a medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.... test.
- It’s been 23 months since your last bone density test, or you have a condition that requires more frequent testing.
- The facility where the scan is done accepts Medicare.
Frequent Bone Density Tests
You may qualify for more frequent testing if you have any of the following conditions:
- Rheumatoid arthritis
- Chronic kidney disease
- Overactive parathyroid gland and other hormonal imbalances
- Diabetes
- Organ transplant
How Much Do Bone Density Tests Cost?
The cost for bone density tests can vary from area to area, ranging from $150 to $325 without coverage3Howmuchisit.org, “How Much Does a Bone Density Scan Cost?“, Accessed November 11, 2021. Medicare beneficiaries who meet the requirements pay no deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share...., coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. ..., or copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.... for a bone density test if their health care providerA person or organization that’s licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.... accepts Medicare assignment.2Medicare.gov, “Bone mass measurements“, Accessed November 11, 20214KFF.org, “Your Guide to Medicare’s Preventive Services“, Accessed November 11, 2021
Medicare Advantage
Medicare Advantage plans are required to cover the same services as Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.... and Part B, in addition to any expanded services offered. That includes bone density tests. However, a beneficiary’s out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.... with a Medicare Advantage plan may be different than those with Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..... Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds.....5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 11, 2021
In Summary
Like most diagnostic and preventative care services, Medicare will completely cover the costs of your bone density tests. If you have a family history of osteoporosis, you broke a bone with unusual ease, or you have been losing height, you should consult with your doctor for this test. Once your doctor has determined that you have a qualifying condition and gives the order for the test, Medicare will have you fully covered for it.
Citations
- 1mayoclinic.org, “Bone density test“, Accessed November 11, 2021
- 2Medicare.gov, “Bone mass measurements“, Accessed November 11, 2021
- 3Howmuchisit.org, “How Much Does a Bone Density Scan Cost?“, Accessed November 11, 2021
- 4KFF.org, “Your Guide to Medicare’s Preventive Services“, Accessed November 11, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 11, 2021