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Fall-related hospitalizations account for approximately 800,000 hospitalizations per year, according to the Centers for Disease Control and Prevention (CDC).
Seniors are at greater risk of falling in their homes, especially those living alone. And these falls can often lead to fractures or broken bones.
If you or a loved one has a broken bone and needs treatment, you may wonder, “Does Medicare cover broken bones?” In this article, we answer the question in clear, plain English.
Does Medicare Cover Broken Bones?
The short answer is yes; Medicare will cover the cost of treatment for broken bones. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your treatment for broken bones. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for treatment for broken bones, including surgeries for severe breaks. Original Medicare provides coverage for additional treatments you may need after falling, but not all of them.
Original Medicare provides coverage for treatment for broken bones if it is considered medically necessary. Your healthcare provider must first order the treatment for Original Medicare to provide coverage. Original Medicare provides coverage for many tests and treatments you need for broken bones, including x-rays.
Coverage for treatment for broken bones is provided by Medicare Part A if your treatment for broken bones takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day you are in the hospital.
After 90 days, Medicare Part A will no longer provide coverage. However, there are 60 lifetime reserve days available to Medicare recipients. If you have them, Medicare will still provide coverage for your hospital stay after 90 days, but you will have a copayment.
Most of the time, coverage for treatment for broken bones is provided by Medicare Part B. It often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of treatment for broken bones. You will pay for the remaining 20 percent.
Medicare Advantage Plans
Medicare Advantage plans (Medicare Part C) also provide coverage for treatment for broken bones. These plans have to cover everything Original Medicare covers. But they will offer some additional benefits as well.
Exactly what it covers and how much the out-of-pocket costs vary depending on your plan’s specifics.
Medicare Part D
Medicare Part D plans provide coverage for medications you may need after treatment for broken bones. It is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Spinal Fusion Surgery?