Medicare Coverage for Osteoporosis: DEXA Scans, Bone Drugs, and Fracture Care

Osteoporosis affects an estimated 10 million Americans and contributes to nearly 2 million bone fractures per year — including the hip fractures that are among the most devastating health events a Medicare beneficiary can experience. The good news: Medicare covers screening, diagnosis, and most treatments for osteoporosis, including both the widely used oral medications and newer injectable biologics. The cost-sharing details, however, depend heavily on which part of Medicare applies to a given service.

DEXA Bone Density Testing Under Part B

Medicare Part B covers bone density measurement tests — most commonly a dual-energy X-ray absorptiometry (DEXA) scan of the hip and spine — at no cost to you if you qualify. The test is fully covered (no coinsurance, no deductible) as a preventive screening benefit when ordered appropriately.

Who qualifies for covered bone density testing:

Women who have been estrogen-deficient for at least two years and are considered at clinical risk for osteoporosis (which includes essentially all postmenopausal women)
Individuals whose X-rays show abnormalities suggestive of vertebral osteoporosis or bone loss
People receiving long-term glucocorticoid (steroid) therapy
People with primary hyperparathyroidism
Anyone being monitored to assess the response to or effectiveness of an FDA-approved osteoporosis treatment

The coverage frequency is every 24 months (roughly every two years). Your physician may order more frequent testing if you have a specific clinical reason, but Medicare will only pay the standard frequency without additional justification.

T-score interpretation: A DEXA test produces a T-score comparing your bone density to that of a healthy 30-year-old:

T-score above -1.0: normal bone density
T-score between -1.0 and -2.5: osteopenia (low bone mass, not yet osteoporosis)
T-score -2.5 or below: osteoporosis

The FRAX tool, which your doctor may use alongside the DEXA, estimates your 10-year probability of fracture and helps guide treatment decisions regardless of T-score alone.

Part D Coverage for Oral Osteoporosis Medications

The most commonly prescribed osteoporosis medications are oral bisphosphonates, which reduce bone breakdown and lower fracture risk. These are covered under Medicare Part D (drug plans) as standard prescription medications.

Common Part D-covered bisphosphonates:

Alendronate (Fosamax): Weekly oral tablet; generic widely available and typically Tier 1 or Tier 2 on most formularies, meaning low to moderate copays
Risedronate (Actonel, Atelvia): Weekly or monthly tablet; generic available
Ibandronate (Boniva): Monthly oral tablet; generic available

Key 2025 Part D cost update: The $2,000 annual out-of-pocket cap under Part D means that even if your osteoporosis drugs are in a higher formulary tier, your total drug costs are capped for the year. For most patients on generic bisphosphonates, annual costs are modest — often under $100 for the year after copays. See Medicare Part D explained for full details on how the coverage phases and cap work.

Estrogen receptor modulators: Raloxifene (Evista), a selective estrogen receptor modulator used in postmenopausal women for both osteoporosis and breast cancer risk reduction, is also covered under Part D.

Part B Coverage for IV and Injectable Osteoporosis Drugs

Several osteoporosis medications are administered by injection or infusion in a clinical setting — and these fall under Medicare Part B rather than Part D. This distinction matters because Part B coverage is 80/20 (Medicare pays 80%, you pay 20% after the deductible), with no annual out-of-pocket cap under Original Medicare.

Zoledronic acid (Reclast): An annual IV infusion administered at an infusion center or physician’s office. Part B covers it as a physician-administered drug. The Medicare-approved rate for zoledronic acid can range from several hundred dollars; your 20% coinsurance is therefore meaningful. For Original Medicare beneficiaries without a Medigap plan, a Reclast infusion may cost $100–$300 or more in coinsurance. Medigap plans that cover Part B coinsurance (Plan G, Plan N) significantly reduce this cost. Medigap plans compared explains what each plan covers.

Denosumab (Prolia): A subcutaneous injection administered by a healthcare provider every six months. Prolia reduces fracture risk by blocking RANKL, a protein that promotes bone breakdown. Because it is administered in a physician’s office, it bills under Part B. The medication itself is expensive (list price over $1,000 per injection), and the 20% Part B coinsurance on that cost can be substantial without a supplement. Medigap Plan G holders pay nothing beyond the deductible.

Important note about Prolia discontinuation risk: Prolia must be continued on schedule. Stopping Prolia without transitioning to another therapy can cause rebound bone loss and significantly elevated fracture risk — a phenomenon well-documented in the literature. If cost is a barrier to continuing Prolia, discuss alternatives with your physician rather than simply stopping.

Romosozumab (Evenity): A monthly subcutaneous injection given over 12 months, then followed by a bisphosphonate or other therapy. Romosozumab is a newer agent that both builds new bone (anabolic effect) and reduces bone breakdown. It is administered in a physician’s office and therefore covered under Part B. It is reserved for women with severe osteoporosis at high fracture risk, particularly those who have already fractured. Part B cost-sharing applies; the 20% coinsurance on this expensive medication can be significant without a Medigap plan.

Abaloparatide (Tymlos) and teriparatide (Forteo): These anabolic agents are self-injected at home, placing them under Part D rather than Part B. They are typically covered on formulary but in higher tiers due to cost; generic teriparatide has become available, lowering costs somewhat. The $2,000 annual Part D cap provides important protection for patients on these high-cost drugs.

Understanding Part B vs. Part D for Osteoporosis Drugs

The rule is this: drugs administered by a healthcare provider in a clinical setting (infused or injected by a nurse or physician) bill under Part B. Drugs you pick up at a pharmacy and self-administer — including self-injectable medications — bill under Part D.

For osteoporosis patients, this means:

Weekly Fosamax tablet → Part D
Monthly Boniva tablet → Part D
Self-injectable Forteo or Tymlos at home → Part D
Annual Reclast IV infusion at an infusion center → Part B
Every-six-months Prolia injection at your doctor’s office → Part B
Monthly Evenity injection at your doctor’s office → Part B

For a detailed explanation of this Part B vs. Part D drug split, see Medicare Part B vs. Part D drugs: which covers what.

Fracture Hospitalization Under Part A

If osteoporosis leads to a fracture — particularly a hip fracture — hospitalization is covered under Medicare Part A.

A hip fracture is a major medical event. Surgical repair (typically hip replacement or ORIF — open reduction internal fixation) requires a hospital stay billed under Part A. Your cost-sharing:

Days 1–60: You pay the Part A inpatient deductible ($1,676 in 2025) and then nothing for days 1–60
Days 61–90: Daily coinsurance ($419/day in 2025)
Days 91+: Lifetime reserve days apply, then no Medicare coverage

Most hip fracture hospitalizations are 3–5 days, keeping costs within the inpatient deductible. Medigap plans cover the Part A deductible (Plan G, Plan A, Plan N all do so). See Medicare Part A coverage for the full inpatient cost structure.

Skilled Nursing Facility Coverage After Hip Fracture

Hip fracture is the most common reason Medicare beneficiaries enter a skilled nursing facility (SNF) for rehabilitative care after hospitalization. Part A covers SNF care:

Coverage requirements:

You must have had a qualifying inpatient hospital stay of at least 3 days (observation status does NOT count — you must be formally admitted)
You must need skilled care: physical therapy, occupational therapy, skilled nursing
You must be admitted to a Medicare-certified SNF within 30 days of hospital discharge

Cost-sharing for SNF:

Days 1–20: $0 (Medicare covers entirely)
Days 21–100: $209.50/day coinsurance in 2025 (paid by Medigap Plan G or C; paid as a copay under most MA plans)
Day 101+: No Medicare coverage; Medicaid, long-term care insurance, or private pay applies

The 3-day qualifying hospital stay requirement is important. Patients held under observation status — a billing classification that looks like inpatient care but technically isn’t — do not qualify for SNF coverage. Confirm your admission status if you are hospitalized for a fracture. See Medicaid planning for long-term care if SNF care extends beyond what Medicare covers.

Home Health Coverage After Fracture

If you are homebound after a hip fracture or vertebral fracture — meaning leaving home requires considerable effort — Medicare Part A and Part B cover home health services:

Skilled nursing visits
Physical therapy and occupational therapy
Speech therapy (if applicable)
Home health aide services (when skilled care is also ongoing)

Home health is covered with no coinsurance and no deductible as long as you meet the homebound criterion and care is medically necessary. You pay nothing for Medicare-covered home health visits. Medicare Part A coverage covers the home health eligibility requirements in detail.

Calcium and Vitamin D: Not Covered

One important gap: Medicare does not cover calcium supplements or vitamin D supplements as standalone over-the-counter products. These are not prescription drugs and are therefore excluded from Part D.

Prescription-strength vitamin D (ergocalciferol or cholecalciferol at doses requiring a prescription) may be covered under Part D if your physician prescribes it for a documented deficiency. But the typical calcium/vitamin D supplements from a pharmacy or health food store are an out-of-pocket expense. Most people with osteoporosis take calcium (1,000–1,200 mg/day from food and supplements) and vitamin D (800–2,000 IU/day); budget $15–$30/month for these.

Low-Income Help for Osteoporosis Drug Costs

If you have limited income, two programs help with Part D drug costs:

Extra Help (Low Income Subsidy): Federal program that pays Part D premiums, deductibles, and reduces copays to nominal amounts ($4.50–$11.20 for most drugs in 2025). Fully covered by Extra Help, even expensive Prolia injections become very low-cost at the pharmacy… but Prolia is Part B, not Part D.

Medicare Savings Programs (MSPs): For Part B cost-sharing, QMB (Qualified Medicare Beneficiary) pays your 20% Part B coinsurance — which matters for Part B osteoporosis drugs like Prolia and Reclast. See Medicare Savings Programs for eligibility and how to apply.

Putting It All Together: A Cost Example

Consider a Medicare beneficiary on Original Medicare (Part B only, no Medigap) who needs:

Annual DEXA scan: $0 (preventive, no coinsurance)
Monthly Fosamax (generic alendronate) via Part D: ~$5–$15/month copay at Tier 1
Annual Reclast infusion via Part B: 20% of Medicare-approved rate, ~$200–$400

With Medigap Plan G: the Reclast 20% coinsurance is fully covered after the annual Part B deductible ($257). Annual drug costs are modest.

With Medicare Advantage: check your plan’s formulary and drug tier for alendronate or zoledronic acid; check whether the infusion facility is in-network.

Key Takeaways

Osteoporosis management under Medicare is well-covered with the right combination of Part B and Part D:

DEXA scans every two years are free under Part B for qualified individuals
Generic bisphosphonates (alendronate, risedronate) are inexpensive under Part D
IV and injected drugs (Reclast, Prolia, Evenity) are Part B drugs — 20% coinsurance applies without a Medigap plan
Medigap Plan G eliminates virtually all Part B coinsurance including for osteoporosis infusions
Hip fracture triggers Part A hospitalization and potentially SNF coverage — the 3-day qualifying stay requirement matters
Calcium and vitamin D supplements are not covered; budget for them separately

For most Medicare beneficiaries, the biggest cost protection decision is whether to carry Medigap or rely on Medicare Advantage — and that choice shapes what you pay for expensive osteoporosis therapies like Prolia and Reclast. The full cost comparison between Medicare Supplement and Advantage plans can help you model the right approach for your situation.