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Does Medicare Cover Hip Replacement?

March 23, 2022

Does Medicare Cover Hip Replacement?

As you age, you may develop pain in your joints that can impact your ability to enjoy everyday activities. That’s why some older Americans look at hip replacement surgery as an option. If you have Medicare as your health insurance coverage, you’re probably wondering “Does Medicare cover hip replacement?” or “Does Medicare cover rehab after hip replacement surgery?”

This guide will help you understand the costs of hip replacement surgery and whether you can rely on your Medicare plan to help you pay for it.

What Medicare Plans Cover Hip Replacements?

Medicare will cover hip replacement if your doctor determines it to be medically necessary.

In Original Medicare, you’ll have coverage for hip replacement under Parts A and B. Part A will provide coverage if you are an inpatient at the hospital. An inpatient procedure often requires one to four days in the hospital depending on your medical needs.

If you have outpatient surgery for your hip, it will be covered under Medicare Part B.

Does Medicare Advantage cover hip replacement? Yes, Medicare Part C plans are required to cover at least as much as Original Medicare. However, your out-of-pocket costs might be different, so be sure to check with your plan before you get surgery.

Does Medicare cover physical therapy after hip replacement? Physical therapy will be covered on a limited basis to help you recover from the hip replacement surgery. If you go home after surgery and receive physical therapy as an outpatient with Original Medicare, your rehab will be covered under Medicare Part B. If you medically require an inpatient skilled nursing facility or rehabilitation facility, that would be under your Medicare Part A coverage.

How Much Does a Hip Replacement Cost?

If you have Medicare and use a provider that accepts assignments, the cost of a hip replacement surgery will be the Medicare-approved amount. The exact dollar cost will depend on your medical needs and what specialty doctors are involved. You’ll be responsible for your coinsurance amount.

If you have a Medicare Advantage plan, the insurance company will have an approved amount that they pay to the medical providers for their care. You’ll pay a copayment or deductible for your portion.

How Much Does Medicare Pay for Hip Replacement Surgery?

Understanding how much Medicare pays for surgery requires knowing which part of Medicare applies. If you have inpatient surgery, Medicare will pay the full Medicare-approved amount minus your Part A deductible and any coinsurance that applies. Because most inpatient stays for hip surgery are short, you may not have any coinsurance.

If you have outpatient surgery using Part B, Medicare will pay 80% of the Medicare-approved cost after your deductible, and you will pay the remaining 20%.

What about Medicare Advantage? If you have a Part C plan, the amount you pay will depend on the deductible, copayments, and coinsurance specified in your plan. Be sure to contact your insurer before you agree to treatment so you know what to expect.

Does Medicare pay for home health care after hip replacement surgery? Both Original Medicare and Medicare Advantage will cover outpatient rehabilitation after hip surgery, but in-home health care is only available if your doctor certifies that you are homebound.

Learn More About Medicare and Hip Replacement

This guide answered the questions we often receive about how Medicare covers hip replacement surgery. If you have questions about your specific situation, or you want to compare Medicare plans to ensure you have the best one for your needs, contact us today!

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