Medicare typically covers hip replacement surgery after a doctor confirms that it is medically necessary.
Hip replacement surgery can help with mobility and maintaining a healthy lifestyle. Surgeons complete more than 400,000 of these procedures each year in the United States.
In this article, we describe which Medicare plans cover hip replacement surgery, including specifics about the coverage, eligibility, and costs. We then describe what the surgery entails.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
There will still be out-of-pocket costs, such as deductibles and copayments. If a person has a Medicare supplement plan — also called a Medigap plan — it can help with these costs.
Original Medicare refers to Medicare Part A and Part B. This covers various costs of the surgery. Medicare Advantage plans have to match this coverage, but they can also provide other benefits. We give a detailed breakdown of the coverage below.
Medicare Part A
During an inpatient stay at a Medicare-approved hospital, Part A covers some expenses related to hospitalization:
- a semiprivate room with a private bathroom
- drugs administered in the hospital, including those that relieve or prevent pain and inflammation
- nursing care
If a person needs additional care, they may move into a skilled nursing facility. Medicare Part A covers the first 100 days of a stay in one of these facilities, including the cost of any physical therapy.
Medicare Part B
To prepare for hip replacement surgery, a person needs minor outpatient procedures and care. This may involve:
- a general physical examination
- a full hip examination
- blood tests
- an MRI
Medicare Part B contributes to these outpatient costs.
When a person has left the hospital after their surgery, Medicare Part B may cover physical therapy and the cost of durable medical equipment, such as a cane or walker.
If a person has their hip replacement surgery at an outpatient surgical facility, they can return home the same day. In this case, Part B provides coverage for the associated costs.
Medicare Part D
Private insurance companies offer Medicare Part D plans. These cover prescription drugs that a person takes at home.
When recovering from a hip replacement surgery, a person may need:
- prescription pain medications, including nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol)
- blood thinners, such as warfarin (Coumadin), to prevent clotting
- anti-inflammatories, if there is excess inflammation
Private companies sell Medigap plans. These are designed to help fill the gaps in original Medicare’s coverage. A person can use this tool to compare plans.
It may also be a good idea to check for any coverage through Medicaid or a spouse’s employer.
The American Association of Hip and Knee Surgeons (AAHKS) reports that the price of hip replacement surgery in the U.S. can be $30,000–112,000. The hip implant costs about $3,000–10,000, and the overall cost also includes staff and surgeon fees.
The average surgeon reimbursement from Medicare for this surgery is $1,375–1,450, according to the AAHKS.
Generally, the amount that a person with Medicare pays depends on whether they have met deductibles and premiums. A doctor can give more specific information about the cost to expect.
The annual deductible for Medicare Part A is $1,484, and for Part B it is $203. Most people do not pay a premium for Part A, and for Part B, the standard monthly premium in 2021 is $148.50.
Medicare part A usually pays 100% percent of the remaining costs after a person meets the deductibles and premium. Medicare Part B pays 80%. This leaves the person to pay the remaining 20% plus their deductibles and premium.
A person can check whether they have met their deductibles here.
This procedure is also called “total hip arthroplasty.” It involves replacing a damaged hip joint with an artificial joint, and a doctor may recommend it when other treatments and techniques have been ineffective.
Surgeons can use a traditional or minimally invasive technique. The main difference is the incision length. The conventional technique requires an incision of
During the procedure, the surgeon cuts through the thigh bone and removes any damaged tissue along with the joint. Next, they attach an artificial joint to the thigh bone with surgical cement or screws. Finally, they close the muscles and skin and may insert a drainage tube.
People usually spend
When damage to the hip joint does not respond to other treatments, a doctor may recommend hip replacement surgery. Medicare typically provides coverage after the doctor confirms the necessity of the procedure.
The extent of Medicare’s coverage depends on several factors, including the person’s Medicare plans, the hospital and outpatient fees, and the state in which the surgery takes place.
People should confirm the potential costs with their doctor and hospital before the surgery.