Just by doing a brief research on Medicare, you’ll realize that Medicare only covers treatments which are medically essential. Medicare comes with certain restrictions in regards to what conditions need to be present in order to cover treatment for osteoporosis.
BMM (also known as Bone Mass Measurement):
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It is a medical test which evaluates your bone health. The test can identify the presence of osteoporosis in a person, determine whether they are at risk of fractures, as well as estimate how the individual’s body will react to the procedure.
A Medigap or Medicare Supplemental plan is likely to cover copayments that are not included in the original Medicare plan. In case you don’t have a supplement, you’ll need to pay the remaining 20 percent out of your own pocket.
Part B Medicare can cover the test once every 2 years if a person satisfies the below criteria and is eligible for Part B Medicare:
An individual whose X-rays reflect the possibility of osteopenia, vertebral fractures or osteoporosis.
People consuming steroid or prednisone type medications or considering to start this treatment.
An individual who’s diagnosed with a primary level of hyperparathyroidism
A person who’s being monitored for seeing whether the osteoporosis drug treatment is working for him/her.
A woman who is both at risk of osteoporosis and estrogen deficient as per the statement of her doctor.
The cost in Initial Medicare:
The good news is since co-insurance is eliminated for this test, eligible persons can receive the service without having to pay anything out of their own pocket as long as the physician accepts Medicare patients.
Part A & Part B:
The basic Medicare pays for medicines that are required to be injected (unlike oral medicines). Also, your Medicare policy will pay for the home visit of the nurse if required.
Eligibility Criteria for Injectable Drugs?
Women meeting the below criteria:
Are a beneficiary of Part B Medicare.
Eligible for health services in their home.
Have fracture related to osteoporosis.
Are unable to take the drug on their own, nor do they’ve got a person who can.
Your expenditure in basic Medicare:
You’ll be paying twenty percent of the amount approved by Medicare for drug cost, along with Medicare Part B deductible. You won’t need to pay anything for the home healthcare service that includes a visit of the nurse for injecting the drug.
Finding suitable Part D plan:
The drug formulary in Part D varies each time.
Also, the drugs listed in the formulary might be different than the ones prescribed by your doctor.
Beneficiaries who’re eligible for original Medicare are also eligible for Part D.
The base amount for the premium of Medicare Part D is $35.02 which could vary based on your selected plan & your income. In addition to the premium, you’ll pay for the copays. The costs may add up considerably in case your medications come under higher tiers. So, it’s crucial for you to check the formulary before enrollment.